Black race independently confers reduced odds of surgery; mortality higher for those without surgery
THURSDAY, July 9, 2020 (HealthDay News) — Black patients with esophageal cancer have a reduced likelihood of receiving surgery, and patients not undergoing surgery have higher mortality, according to a study published online June 4 in the Journal of Gastrointestinal Surgery.
Samantha L. Savitch, from the Thomas Jefferson University Hospital in Philadelphia, and colleagues identified patients with stage I to III esophageal cancer from 2004 to 2015 using the National Cancer Database. Factors associated with receipt of surgery were examined, and modeling was performed to control for random effects of individual hospitals on surgical utilization.
Data were included for 60,041 patients (4,402 black and 55,639 white patients); 5,858 patients evenly distributed across race were included after 1:1 matching. The researchers found that significantly fewer black than white patients received surgery for all stages. In a single-level multivariable analysis and after controlling for hospital random effects, black race independently conferred a lower likelihood of receiving surgery (odds ratios for stage I, II, and III: 0.67, 0.76, and 0.62, respectively). One-third of the unexplained variance in receipt of surgery was explained by hospital-level random effects. Patients who did not undergo surgery had higher risk-adjusted one-, three-, and five-year mortality.
“Improved education of patients and providers regarding treatment guidelines to ensure receipt of surgery in appropriate surgical candidates may improve outcomes for black patients with esophageal cancer,” the authors write.
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