Race/ethnicity and socio-economic differences in colorectal cancer surgery outcomes: analysis of the nationwide inpatient sample.
The purpose of this study was to examine racial and socio-economic differences in the receipt of laparoscopic or open surgery among patients with colorectal cancer, and to determine if racial and socio-economic differences exist in post-surgical complications, in-hospital mortality and hospital length of stay among patients who received surgery.



We conducted a cross-sectional analysis of hospitalized patients with a primary diagnosis of colorectal cancer between 2007 and 2011 using data from Nationwide Inpatient Sample. ICD-9 codes were used to capture primary diagnosis, surgical procedures, and health outcomes during hospitalization. We used logistic regression analysis to determine racial and socio-economic predictors of surgery type, post-surgical complications and mortality, and linear regression analysis to assess hospital length of stay.



A total of 122,631 patients were admitted with a primary diagnosis of malignant colorectal cancer between 2007 and 2011. Of these, 17,327 (14.13 %) had laparoscopic surgery, 70,328 (57.35 %) received open surgery, while 34976 (28.52 %) did not receive any surgery. Black (36 %) and Hispanic (34 %) patients were more likely to receive no surgery compared with Whites (27 %) patients. However, among patients that received any surgery, there were no racial differences in which surgery was received (laparoscopic versus open, p = 0.2122), although socio-economic differences remained, with patients from lower residential income areas significantly less likely to receive laparoscopic surgery compared with patients from higher residential income areas (OR: 0.74, 95 % CI: 0.70-0.78). Among patients who received any surgery, Black patients (OR = 1.07, 95 % CI: 1.01-1.13), and patients with Medicare (OR = 1.16, 95 % CI: 1.11-1.22) and Medicaid (OR = 1.15, 95 % CI: 1.07-1.25) insurance experienced significantly higher post-surgical complications, in-hospital mortality (Black OR = 1.18, 95 % CI: 1.00-1.39), and longer hospital stay (Black β = 1.33, 95 % CI: 1.16-1.50) compared with White patients or patients with private insurance.



Racial and socio-economic differences were observed in the receipt of surgery and surgical outcomes among hospitalized patients with malignant colorectal cancer in the US.
Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, 35294-0022, USA. tomiakin@uab.edu.|Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA. tomiakin@uab.edu.
Tomi
T
Akinyemiju
Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, 35294-0022, USA.
Qingrui
Q
Meng
University of Northern Colorado Cancer Rehabilitation Institute, Greeley, Colorado, USA.|School of Social Work, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado, USA.
Neomi
N
Vin-Raviv
D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000601:surgery*; D003430:Cross-Sectional Studies; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data; D005006:Ethnicity; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D017052:Hospital Mortality / Q000208:ethnology; D006801:Humans; D007297:Inpatients; D010535:Laparoscopy / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D044469:Racial Groups; D012959:Socioeconomic Factors; D014481:United States