Blacks are disproportionately burdened with colorectal cancer. Several studies have attributed racial disparities in incidence and mortality to variances in socioeconomic status and health insurance coverage. However, an Institutes of Medicine report found that Blacks received lower quality care than Whites even when controlling for health insurance, income, and severity of conditions.
To examine the effects of race on colorectal cancer outcomes within a single setting, authors performed a retrospective cohort study that analyzed the billing, medical, and cancer registry records of 365 university hospital patients (175 Blacks and 190 Whites) diagnosed with stage II-IV colon cancer between 2000 and 2005. Racial differences in the quality (effectiveness and timeliness) of stage-specific colon cancer treatment (colectomy and chemotherapy) were examined after adjusting for socioeconomic status, health insurance coverage, gender, age, and marital status.
Blacks and Whites had similar sociodemographic characteristics, tumor stage and site, quality of care, and health outcomes. Age and diagnostic stage were predictors of quality of care and mortality. Although a very small percentage of patients (5.8%) were uninsured, they were more likely to present at advance stages (61.9% at stage IV) and die (76.2%) than privately insured and publicly insured patients.
Findings suggest patients who receive the same quality of care, regardless of racial distinction, have similar health outcomes. Age, diagnostic stage and health insurance coverage were independently associated with mortality. Future studies on disparities in colon cancer treatment should examine socio-cultural barriers to accessing appropriate and equitable care in different healthcare settings.