Racial Disparities in Colorectal Cancer Mortality: the Role of Endoscopy Wait-Time and Stage at Diagnosis
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Racial Disparities in Colorectal Cancer Mortality: the Role of Endoscopy Wait-Time and Stage at Diagnosis Rachel B. Issaka 1,2,3
&
Li Li 2 & Catherine Fedorenko 2 & Cynthia W. Ko 3 & John M. Inadomi 3 & Scott D. Ramsey 2
Received: 18 November 2019 / Revised: 3 February 2020 / Accepted: 4 February 2020 # W. Montague Cobb-NMA Health Institute 2020
Abstract Introduction In Western Washington (WA), colorectal cancer (CRC) mortality between 2012 and 2016 was highest in American Indian/Alaska Natives (AI/AN) and African-Americans (AA) at 20.7 and 18.7, respectively, compared with non-Hispanic Whites at 14.1/100,000 people. We hypothesized that time from billed encounters for CRC-associated symptoms to endoscopy completion or CRC stage at diagnosis contributed to observed differences. Methods Using administrative insurance claims linked to WA cancer registry data, we performed a retrospective cohort study of patients diagnosed with CRC between 2011 and 2017, with continuous insurance for 15 months prior to diagnosis and a billed encounter for CRC-associated symptoms. We determined the wait-time (days) and stage at diagnosis and conducted logistic regression analysis to identify the factors associated with endoscopy completion. Results Of the 3461 CRC patients identified, 57% had stage 2 or 3 disease with no differences in stage by race, and 84% completed an endoscopy after a billed encounter for CRC-associated symptoms. The median wait-time to endoscopy was 52 days (IQR 14–218) without differences by race. Compared with patients diagnosed with stage 1 CRC, patients with stage 4 CRC were more likely to complete an endoscopy within the first quartile of time (22.2% vs. 17.4%, p < 0.01). Living arrangement, insurance type, and comorbidity, but not race, were significant factors associated with endoscopy completion. Conclusions We found no statistically significant differences in time from billed CRC-associated symptoms to endoscopy completion or in CRC stage among AA and AI/AN compared to Whites. This suggests that other factors are more likely to contribute to observed mortality disparities. Keywords Colorectal cancer . Disparities . Administrative claims . Cancer registry
Introduction Colorectal cancer (CRC) is the third most common cancer and second-leading cause of cancer death in Washington (WA) state Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40615-020-00721-x) contains supplementary material, which is available to authorized users. * Rachel B. Issaka [email protected] 1
Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M/S: M3-B232, Seattle, WA 98109, USA
2
Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M/S: M3-B232, Seattle, WA 98109, USA
3
Division of Gastroenterology, University of Washington School of Medicine, 1100 Fairview Ave. N., M/S: M3-B232, Seattle, WA 98109, USA
[1]. In Western WA, between 2012 and 2016, CRC mortality was highest in A
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