title: Insurance Status, Not Race, is Associated With Use of Minimally Invasive Surgical Approach for Rectal Cancer.
abstract: OBJECTIVE
  To determine the impact of race and insurance on use of minimally invasive (MIS) compared with open techniques for rectal cancer in the United States.
  
  
  BACKGROUND
  Race and socioeconomic status have been implicated in disparities of rectal cancer treatment.
  
  
  METHODS
  Adults undergoing MIS (laparoscopic or robotic) or open rectal resections for stage I to III rectal adenocarcinoma were included from the National Cancer Database (2010-2012). Multivariate analyses were employed to examine the adjusted association of race and insurance with use of MIS versus open surgery.
  
  
  RESULTS
  Among 23,274 patients, 39% underwent MIS and 61% open surgery. Overall, 86% were white, 8% black, and 3% Asian. Factors associated with use of open versus MIS were black race, Medicare/Medicaid insurance, and lack of insurance. However, after adjustment for patient demographic, clinical, and treatment characteristics, black race was not associated with use of MIS versus open surgery [odds ratio [OR] 0.90, P = 0.07). Compared with privately insured patients, uninsured patients (OR 0.52, P < 0.01) and those with Medicare/Medicaid (OR 0.79, P < 0.01) were less likely to receive minimally invasive resections. Lack of insurance was significantly associated with less use of MIS in black (OR 0.59, P = 0.02) or white patients (OR 0.51, P < 0.01). However, among uninsured patients, black race was not associated with lower use of MIS (OR 0.96, P = 0.59).
  
  
  CONCLUSIONS
  Insurance status, not race, is associated with utilization of minimally invasive techniques for oncologic rectal resections. Due to the short-term benefits and cost-effectiveness of minimally invasive techniques, hospitals may need to improve access to these techniques, especially for uninsured patients.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Megan
authors.initials: M
authors.lastname: Turner
authors.forename: Mohamed Abdelgadir
authors.initials: MA
authors.lastname: Adam
authors.forename: Zhifei
authors.initials: Z
authors.lastname: Sun
authors.forename: Jina
authors.initials: J
authors.lastname: Kim
authors.forename: Brian
authors.initials: B
authors.lastname: Ezekian
authors.forename: Babatunde
authors.initials: B
authors.lastname: Yerokun
authors.forename: Christopher
authors.initials: C
authors.lastname: Mantyh
authors.forename: John
authors.initials: J
authors.lastname: Migaly
mesh_terms: D000230:Adenocarcinoma / Q000208:ethnology / Q000473:pathology / Q000601:surgery; D000368:Aged; D015331:Cohort Studies; D003082:Colectomy / Q000191:economics / Q000379:methods* / Q000401:mortality; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000191:economics*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D011351:Proctoscopy / Q000379:methods / Q000706:statistics & numerical data; D044469:Racial Groups; D012004:Rectal Neoplasms / Q000208:ethnology* / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States