Does serum albumin explain observed racial disparities in mortality for cancer patients undergoing esophagectomy?

Abstract

Background: African Americans with esophageal cancer have a higher mortality rate than Caucasians. We hypothesized that nutritional status, as reflected by preoperative albumin, might explain these disparities.

Methods: The National Surgical Quality Improvement Program database was queried for patients undergoing esophagectomy for esophageal cancer between 2005 and 2015. Preoperative albumin was divided into five categories (<3.0, 3.0-3.4, 3.5-3.9, 4.0-4.4, and >4.4). Univariate and multivariable regression statistics were performed to determine an association between preoperative albumin levels on mortality.

Results: 3228 patients were studied. While preoperative albumin was associated with lower body mass index, more severe preoperative weight loss, and more respiratory comorbidities (p-values <0.05), albumin levels were not associated with race. On multivariable models including race and other covariates, we found no association of serum albumin and mortality.

Conclusions: We found that race was an independent predictor of mortality for patients undergoing esophagectomy. However, preoperative albumin did not explain these disparities.

Keywords: Albumin; Esophageal cancer; Esophagectomy; Malnutrition; Racial disparities.