title: Ethnic Inequalities in Rectal Cancer Care in a Universal Access Healthcare System: A Nationwide Register-Based Study.
abstract: BACKGROUND
  Ethnic inequalities in colorectal cancer care were reported previously in the United States. Studies specifically reporting on ethnic inequalities in rectal cancer care are limited.
  
  
  OBJECTIVE
  This study aimed to explore potential ethnic inequalities in rectal cancer care in the Netherlands.
  
  
  METHODS
  This was a nationwide, population-based observational study.
  
  
  METHODS
  The study linked data of the Netherlands Cancer Registry with the Dutch population registry and the Social Statistics Database of Statistics Netherlands. Data were analyzed using stepwise multivariable logistic regression models.
  
  
  METHODS
  All of the patients diagnosed with rectal carcinoma in 2003-2011 in the Netherlands (N = 27,159) were included.
  
  
  METHODS
  We analyzed 2 rectal cancer treatment indicators (preoperative radiotherapy and sphincter-sparing surgery) and 2 indicators of short-term outcome of rectal cancer surgery (anastomotic leakage and 30-day postoperative mortality).
  
  
  RESULTS
  Patients of Western non-Dutch and non-Western origin with rectal cancer were significantly younger and had a higher tumor stage than ethnic Dutch patients. Considering preoperative radiotherapy, anastomotic leakage, and 30-day postoperative mortality, no ethnic inequalities were detected. After adjustment for age, sex, disease characteristics, and socioeconomic status, Western non-Dutch and non-Western patients were significantly more likely to receive sphincter-sparing surgery than ethnic Dutch patients (OR = 1.27 (95% CI, 1.04-1.55) and OR = 1.57 (95% CI, 1.02-2.42)).
  
  
  CONCLUSIONS
  This study was limited by the relatively low numbers of non-Dutch patients with rectal cancer.
  
  
  CONCLUSIONS
  Non-Dutch ethnic origin was associated with a higher rate of sphincter-sparing surgery. The absence of ethnic inequalities in preoperative radiotherapy, anastomotic leakage, and 30-day postoperative mortality suggests that ethnic minority patients have similar chances of optimal rectal cancer care outcomes as Dutch patients.
authors.affiliation: 1 Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands 2 Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands 3 Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands 4 Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Marloes A G
authors.initials: MA
authors.lastname: Elferink
authors.forename: Majda
authors.initials: M
authors.lastname: Lamkaddem
authors.forename: Evelien
authors.initials: E
authors.lastname: Dekker
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Tanis
authors.forename: Otto
authors.initials: O
authors.lastname: Visser
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Essink-Bot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D012004:Rectal Neoplasms / Q000208:ethnology / Q000401:mortality / Q000628:therapy*; D012042:Registries; D013222:State Medicine; D016896:Treatment Outcome