Disparities in Guideline-Concordant Treatment and Survival Among Border County Residents With Gastric Cancer

Abstract

Purpose: Previous studies have shown health disparities among US-Mexico border county (BC) residents. However, the impact of BC residence on gastric cancer treatment and survival outcomes is unknown. Our study compares the receipt of guideline-concordant care (GCC) and survival for patients with gastric cancer by BC status.

Methods: We conducted a retrospective review of adult non-Hispanic White and Hispanic patients with gastric adenocarcinoma diagnosed between 2004 and 2017 in the Texas Cancer Registry. Chi-square tests were used to compare categorical group differences, with pooled t-tests used to compare group means. The impact of BC residence on likelihood of receiving GCC was assessed with logistic regression. Overall survival was estimated using the Kaplan-Meier method and compared with log-rank tests.

Results: Our cohort consisted of 12,514 patients (15% BC). Overall, 45% of nonborder county residents received GCC versus 35% of BC residents (P < .0001). After adjusting for age, race, stage, and insurance status, BC patients remained significantly less likely to receive GCC (odds ratio 0.69; 95% CI, 0.61 to 0.78). BC residence was associated with increased hazard of all-cause mortality after accounting for age, race, stage, poverty index, and treatment receipt (hazard ratio 1.11; 95% CI, 1.04 to 1.18). BC residents had significantly worse overall survival for localized and regional disease.

Conclusion: BC residents with gastric cancer are less likely to receive GCC and have significantly worse survival outcomes than nonborder county residents. This highlights significant health care disparities arising from the lack of health care access and multiple social determinants of health. Further studies are needed to identify specific contributing mechanisms to improve health care equity.