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. 2022 Jul 1;5(7):e2222009.
doi: 10.1001/jamanetworkopen.2022.22009.

Racial and Ethnic Disparities in Cancer Care During the COVID-19 Pandemic

Manali I Patel  1   2 , Jacqueline M Ferguson  2   3 , Eida Castro  4 , Cristina D Pereira-Estremera  5 , Guillermo N Armaiz-Peña  4 , Ysabel Duron  6 , Fay Hlubocky  7 , Analynn Infantado  8 , Bles Nuqui  8 , Donna Julian  8 , Nii Nortey  8 , Alexandra Steck  8 , Melissa Bondy  3 , Shail Maingi  9
Affiliations

Racial and Ethnic Disparities in Cancer Care During the COVID-19 Pandemic

Manali I Patel et al. JAMA Netw Open. .

Abstract

Importance: The full effect of the COVID-19 pandemic on cancer care disparities, particularly by race and ethnicity, remains unknown.

Objectives: To assess whether the race and ethnicity of patients with cancer was associated with disparities in cancer treatment delays, adverse social and economic effects, and concerns during the COVID-19 pandemic and to evaluate trusted sources of COVID-19 information by race and ethnicity.

Design, setting, and participants: This national survey study of US adults with cancer compared treatment delays, adverse social and economic effects, concerns, and trusted sources of COVID-19 information by race and ethnicity from September 1, 2020, to January 12, 2021.

Exposures: The COVID-19 pandemic.

Main outcomes and measures: The primary outcome was delay in cancer treatment by race and ethnicity. Secondary outcomes were duration of delay, adverse social and economic effects, concerns, and trusted sources of COVID-19 information.

Results: Of 1639 invited respondents, 1240 participated (75.7% response rate) from 50 US states, the District of Columbia, and 5 US territories (744 female respondents [60.0%]; median age, 60 years [range, 24-92 years]; 266 African American or Black [hereafter referred to as Black] respondents [21.5%]; 186 Asian respondents [15.0%]; 232 Hispanic or Latinx [hereafter referred to as Latinx] respondents [18.7%]; 29 American Indian or Alaska Native, Native Hawaiian, or multiple races [hereafter referred to as other] respondents [2.3%]; and 527 White respondents [42.5%]). Compared with White respondents, Black respondents (odds ratio [OR], 6.13 [95% CI, 3.50-10.74]) and Latinx respondents (OR, 2.77 [95% CI, 1.49-5.14]) had greater odds of involuntary treatment delays, and Black respondents had greater odds of treatment delays greater than 4 weeks (OR, 3.13 [95% CI, 1.11-8.81]). Compared with White respondents, Black respondents (OR, 4.32 [95% CI, 2.65-7.04]) and Latinx respondents (OR, 6.13 [95% CI, 3.57-10.53]) had greater odds of food insecurity and concerns regarding food security (Black respondents: OR, 2.02 [95% CI, 1.34-3.04]; Latinx respondents: OR, 2.94 [95% CI, [1.86-4.66]), financial stability (Black respondents: OR, 3.56 [95% CI, 1.79-7.08]; Latinx respondents: OR, 4.29 [95% CI, 1.98-9.29]), and affordability of cancer treatment (Black respondents: OR, 4.27 [95% CI, 2.20-8.28]; Latinx respondents: OR, 2.81 [95% CI, 1.48-5.36]). Trusted sources of COVID-19 information varied significantly by race and ethnicity.

Conclusions and relevance: In this survey of US adults with cancer, the COVID-19 pandemic was associated with treatment delay disparities and adverse social and economic effects among Black and Latinx adults. Partnering with trusted sources may be an opportunity to overcome such disparities.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Pereira-Estremera reported receiving salary from Tiber Health Public Benefit Corp during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Modifications in Cancer Care, Treatment Delays, and Concerns Regarding Health by Race and Ethnicity
The reference group for all comparisons is White non-Latinx respondents. Models were adjusted for a priori selected sociodemographic (gender identity, age, educational level, income, insurance status, and place of residence) and clinical variables (cancer diagnosis and stage). The other race category comprises American Indian or Alaska Native, Native Hawaiian, and respondents of multiple races. OR indicates odds ratio.
Figure 2.
Figure 2.. Experiences and Concerns Regarding Adverse Social and Economic Effects by Race and Ethnicity
The reference group for all comparisons is White non-Latinx respondents. Models were adjusted for a priori selected sociodemographic (gender identity, age, educational level, income, insurance status, and place of residence) and clinical variables (cancer diagnosis and stage). The other race category comprises American Indian or Alaska Native, Native Hawaiian, and respondents of multiple races. OR indicates odds ratio. aIn the model assessing concerns about child care, 1 iteration of the multiple imputation for unknown cancer stage generated a structural positivity violation in which there were no cases among stage 0. This imputation was excluded, and the results comprise 99 iterations.
Figure 3.
Figure 3.. Trust in Sources for COVID-19 Information by Race and Ethnicity
The reference group for all comparisons is White non-Latinx respondents. Models were adjusted for a priori selected sociodemographic (gender identity, age, educational level, income, insurance status, and place of residence) and clinical variables (cancer diagnosis and stage). The other race category comprises American Indian or Alaska Native, Native Hawaiian, and respondents of multiple races. OR indicates odds ratio.
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