Impact of socioeconomic status on cancer care in Southeast Texas: a retrospective population-based cohort study

Abstract

Background: Gastrointestinal (GI) cancers are the third leading cause of cancer-related mortality worldwide. Disparities in healthcare frequently stem from variations in socioeconomic status (SES). This study investigated the influence of socioeconomic factors such as gender, race, age, and geography on time to treatment initiation (TTI) and survival outcomes.

Methods: The study analyzed SES data, including age, race, geography, and insurance status, from GI cancer patients treated at Baptist Hospitals of Southeast Texas (BHSET) from 2012 to 2017. Logistic regression was performed for risk association. The primary outcomes were survival time and TTI.

Results: Of 517 GI cancer patients, 359 had colorectal cancer. African Americans had higher treatment delays (odds ratio [OR]: 5.89, confidence interval [CI]: 4.02-8.62) than Caucasians (OR: 0.16, CI: 0.11-0.23). Patients >80 years had poorer survival (OR: 2.91, CI: 1.80-4.72) than younger ones. Those living 30 + miles from BHSET had longer TTI (OR: 1.85, CI: 1.19-2.87), especially within the colorectal cancer cohort (OR: 2.20, CI: 1.29-3.74). Medicare Advantage was linked to longer TTI (OR: 1.50, CI: 1.01-2.23). Medicare patients without supplemental insurance had lower survival overall (OR: 1.79, CI: 1.05-3.06) and among colorectal cancer patients (OR: 2.13, CI: 1.14-3.98).

Conclusion: Addressing SES disparities and implementing targeted interventions is imperative to ensure equitable access to timely and effective cancer care.

Keywords: Cancer; Southeast Texas; healthcare outcomes; socioeconomic status; survival analysis.

Figure 1.

Influence of socioeconomic and demographic factors on delay in treatment initiation across all cancer types. The odds ratios and 95% confidence intervals displayed in the Forest plot quantify the strength and statistical significance of the association between each factor and treatment delays.

Figure 2.

Impact of socioeconomic and demographic factors on survival outcomes across all cancer types. The odds ratios and 95% confidence intervals depicted in the Forest plot measure the statistical relationship between each subgroup characteristic and survival outcomes.

Figure 3.

Analysis of socioeconomic and demographic factors affecting treatment delays in colorectal cancer patients. The odds ratios and 95% confidence intervals illustrated in the Forest plot quantify the association between each identified factor and treatment delays in this specific cancer cohort.

Figure 4.

Correlation between socioeconomic and demographic factors and survival outcomes in colorectal cancer patients. The Forest plot displays odds ratios and 95% confidence intervals that quantify the relationship between each factor and survival outcomes.