Abstract
BACKGROUND: Disparities in colon cancer care and outcomes by race/ethnicity, socioeconomic status (SES), and insurance are well recognized; however, the extent to which inequalities are driven by patient factors versus variation in hospital performance remains unclear. We sought to compare disparities in care delivery and outcomes at low- and high-performing hospitals. METHODS: We identified patients with stage I-III colon adenocarcinoma from the 2012-2017 National Cancer Database. Adequate lymphadenectomy and timely adjuvant chemotherapy administration defined hospital performance. Multilevel regression models evaluated disparities by race/ethnicity, SES, and insurance at the lowest- and highest-performance quartile hospitals. RESULTS: Of 92,573 patients from 704 hospitals, 45,982 (49.7%) were treated at 404 low-performing hospitals and 46,591 (50.3%) were treated at 300 high-performing hospitals. Low-performing hospitals treated more non-Hispanic (NH) Black, Hispanic, low SES, and Medicaid patients (all p < 0.01). among low-performing hospitals, patients with low versus high ses (odds ratio [or] 0.87, 95% confidence interval [ci] 0.82-0.92), and medicare (or 0.90, 95% ci 0.85-0.96) and medicaid (or 0.88, 95% ci 0.80-0.96) versus private insurance, had decreased odds of receiving high-quality care. at high-performing hospitals, nh black versus nh white patients (or 0.83, 95% ci 0.72-0.95) had decreased odds of receiving high-quality care. low ses, medicare, medicaid, and uninsured patients had worse overall survival at low- and high-performing hospitals (all p >< 0.01). conclusion: disparities in receipt of high-quality colon cancer care occurred by ses and insurance at low-performing hospitals, and by race at high-performing hospitals. however, survival disparities by ses and insurance exist irrespective of hospital performance. future steps include improving low-performing hospitals and identifying mechanisms affecting survival disparities.>
