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. 2020 Dec 1;3(12):e2027415.
doi: 10.1001/jamanetworkopen.2020.27415.

Changes in Racial Disparities in Mortality After Cancer Surgery in the US, 2007-2016

Miranda B Lam  1   2 , Katherine Raphael  1 , Winta T Mehtsun  1   3 , Jessica Phelan  1 , E John Orav  4   5 , Ashish K Jha  1   4 , Jose F Figueroa  1   6
Affiliations

Changes in Racial Disparities in Mortality After Cancer Surgery in the US, 2007-2016

Miranda B Lam et al. JAMA Netw Open. .

Abstract

Importance: Racial disparities are well documented in cancer care. Overall, in the US, Black patients historically have higher rates of mortality after surgery than White patients. However, it is unknown whether racial disparities in mortality after cancer surgery have changed over time.

Objective: To examine whether and how disparities in mortality after cancer surgery have changed over 10 years for Black and White patients overall and for 9 specific cancers.

Design, setting, and participants: In this cross-sectional study, national Medicare data were used to examine the 10-year (January 1, 2007, to November 30, 2016) changes in postoperative mortality rates in Black and White patients. Data analysis was performed from August 6 to December 31, 2019. Participants included fee-for-service beneficiaries enrolled in Medicare Part A who had a major surgical resection for 9 common types of cancer surgery: colorectal, bladder, esophageal, kidney, liver, ovarian, pancreatic, lung, or prostate cancer.

Exposures: Cancer surgery among Black and White patients.

Main outcomes and measures: Risk-adjusted 30-day, all-cause, postoperative mortality overall and for 9 specific types of cancer surgery.

Results: A total of 870 929 cancer operations were performed during the 10-year study period. In the baseline year, a total of 103 446 patients had cancer operations (96 210 White patients and 7236 Black patients). Black patients were slightly younger (mean [SD] age, 73.0 [6.4] vs 74.5 [6.8] years), and there were fewer Black vs White men (3986 [55.1%] vs 55 527 [57.7%]). Overall national mortality rates following cancer surgery were lower for both Black (-0.12%; 95% CI, -0.17% to -0.06% per year) and White (-0.14%; 95% CI, -0.16% to -0.13% per year) patients. These reductions were predominantly attributable to within-hospital mortality improvements (Black patients: 0.10% annually; 95% CI, -0.15% to -0.05%; P < .001; White patients: 0.13%; 95% CI, -0.14% to -0.11%; P < .001) vs between-hospital mortality improvements. Across the 9 different cancer surgery procedures, there was no significant difference in mortality changes between Black and White patients during the period under study (eg, prostate cancer: 0.35; 95% CI, 0.02-0.68; lung cancer: 0.61; 95% CI, -0.21 to 1.44).

Conclusions and relevance: These findings offer mixed news for policy makers regarding possible reductions in racial disparities following cancer surgery. Although postoperative cancer surgery mortality rates improved for both Black and White patients, there did not appear to be any narrowing of the mortality gap between Black and White patients overall or across individual cancer surgery procedures.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Figueroa reported receiving grants from Commonwealth Fund and Robert Wood Johnson Foundation outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Risk-Adjusted 30-Day Postoperative Mortality for Cancer Operations
See this image and copyright information in PMC

Comment in

References

    1. Virnig BA, Baxter NN, Habermann EB, Feldman RD, Bradley CJ. A matter of race: early-versus late-stage cancer diagnosis. Health Aff (Millwood). 2009;28(1):160-168. doi: 10.1377/hlthaff.28.1.160 - DOI - PMC - PubMed
    1. Morris AM, Wei Y, Birkmeyer NJO, Birkmeyer JD. Racial disparities in late survival after rectal cancer surgery. J Am Coll Surg. 2006;203(6):787-794. doi: 10.1016/j.jamcollsurg.2006.08.005 - DOI - PubMed
    1. Breslin TM, Morris AM, Gu N, et al. Hospital factors and racial disparities in mortality after surgery for breast and colon cancer. J Clin Oncol. 2009;27(24):3945-3950. doi: 10.1200/JCO.2008.20.8546 - DOI - PMC - PubMed
    1. Sukumar S, Ravi P, Sood A, et al. Racial disparities in operative outcomes after major cancer surgery in the United States. World J Surg. 2015;39(3):634-643. doi: 10.1007/s00268-014-2863-x - DOI - PubMed
    1. Mahdi H, Jernigan A, Lockhart D, Moslemi-Kebria M, Rose PG. Racial disparity in 30-day morbidity and mortality after surgery for ovarian cancer. Int J Gynecol Cancer. 2015;25(1):55-62. doi: 10.1097/IGC.0000000000000324 - DOI - PubMed

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