title: Racial disparities in esophageal cancer survival after surgery.
abstract: OBJECTIVE
  Esophageal cancer (EC) black patients have higher mortality rates than Whites. The lower rate of surgery in Blacks may explain the survival difference. We explored the Surveillance Epidemiology and End Results database to determine the impact of surgery on mortality in Blacks and Whites EC.
  
  
  METHODS
  All cases of pathologically proven local and locoregional adenocarcinoma and squamous cell carcinoma of the esophagus from 1973 to 2011 were identified (13,678 White, 2,894 Black patients). Cervical esophageal cancer was excluded. Age, sex, diagnosis year, stage, cancer-directed surgery, radiation, and vital status were analyzed according to self-reported race.
  
  
  RESULTS
  Blacks had higher 1-year mortality, adjusted for age, sex, stage, year of diagnosis, histology, and therapy [adjusted hazard ratio (HRadj ): 1.24 (95% CI 1.16-1.32)]. Undergoing surgery was an independent predictor of improved survival overall (HRadj 0.30, 95% CI 0.27-0.33). Black patients treated surgically experienced significantly lower survival than Whites, but the difference was not observed in those who did not undergo surgery.
  
  
  CONCLUSIONS
  Although surgery appears to reduce mortality overall, early survival is worse for Blacks. Investigation into racial disparities in health care access and delivery, and to skilled esophageal surgeons is warranted to improve survival for all patients, particularly Blacks. J. Surg. Oncol. 2016;113:659-664. © 2016 Wiley Periodicals, Inc.
authors: Department of Thoracic Surgery, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, New York.|Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York.
authors: Emanuela
authors: E
authors: Taioli
authors: Department of Thoracic Surgery, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, New York.
authors: Andrea S
authors: AS
authors: Wolf
authors: Department of Community Health and Social Medicine, Sophie Davis School of Biomedical Education, City College of New York, New York, New York.
authors: Marlene
authors: M
authors: Camacho-Rivera
authors: Department of Thoracic Surgery, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, New York.
authors: Andrew
authors: A
authors: Kaufman
authors: Department of Thoracic Surgery, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, New York.
authors: Dong-Seok
authors: DS
authors: Lee
authors: Mount Sinai Roosevelt and Mount Sinai St. Luke's Hospital, New York, New York.
authors: Faiz
authors: F
authors: Bhora
authors: Department of Thoracic Surgery, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, New York.
authors: Raja M
authors: RM
authors: Flores
mesh_terms: D000230:Adenocarcinoma / Q000208:ethnology / Q000401:mortality* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000208:ethnology / Q000401:mortality* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000208:ethnology / Q000401:mortality* / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018426:SEER Program; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People; D055815:Young Adult
keywords: cancer disparity; epidemiology; health care delivery