Disparities in Access, Quality, and Clinical Outcome for Latino Californians with Colon Cancer

Aaron J Dawes; Ganesh Rajasekar; Katherine D Arnow; Amber W Trickey; Alex H S Harris; Arden M Morris; Todd H Wagner

doi:10.1097/SLA.0000000000006251

Disparities in Access, Quality, and Clinical Outcome for Latino Californians with Colon Cancer

Ann Surg. 2024 Feb 26. doi: 10.1097/SLA.0000000000006251. Online ahead of print.

Authors

Aaron J Dawes^{1

2}, Ganesh Rajasekar², Katherine D Arnow², Amber W Trickey², Alex H S Harris^{2

3}, Arden M Morris^{1

2}, Todd H Wagner^{2

4}

Affiliations

¹ Section of Colon & Rectal Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA.
² Stanford-Surgery Policy Improvement Research and Education Center, Stanford, CA.
³ Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, CA.
⁴ Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, CA.

PMID: 38407273
DOI: 10.1097/SLA.0000000000006251

Abstract

Objective: To compare access, quality, and clinical outcomes between Latino and non-Latino White Californians with colon cancer.

Summary background data: Racial and ethnic disparities in cancer care remain understudied, particularly among patients who identify as Latino. Exploring potential mechanisms, including differential utilization of high-volume hospitals, is an essential first step to designing evidence-based policy solutions.

Methods: We identified all adults diagnosed with colon cancer between January 1, 2010 and December 31, 2020 from a statewide cancer registry linked to hospital administrative records. We compared survival, access (stage at diagnosis, receipt of surgical care, treatment at a high-volume hospital), and quality of care (receipt of adjuvant chemotherapy, adequacy of lymph node resection) between patients who identified as Latino and as non-Latino White.

Results: 75,543 patients met inclusion criteria, including 16,071 patients who identified as Latino (21.3%). Latino patients were significantly less likely to undergo definitive surgical resection (marginal difference [MD] -0.72 percentage points, 95% CI -1.19,-0.26), have an operation in a timely fashion (MD -3.24 percentage points, 95% CI -4.16,-2.32), or have an adequate lymphadenectomy (MD -2.85 percentage points, 95% CI -3.59,-2.12) even after adjustment for clinical and sociodemographic factors. Latino patients treated at high-volume hospitals were significantly less likely to die and more likely to meet access and quality metrics.

Conclusions: Latino colon cancer patients experienced delays, segregation, and lower receipt of recommended care. Hospital-level colectomy volume appears to be strongly associated with access, quality, and survival--especially for patients who identify as Latino--suggesting that directing at-risk cancer patients to high-volume hospitals may improve health equity.