Ball JK, Elixhauser A.
Treatment differences between blacks and whites with colorectal cancer.
Med Care 1996; 34(9):970-84.

The authors examine interracial variations in treatment for over 20,000 patients hospitalized with colorectal cancer in a national sample of hospitals.

Blacks were more likely to be hospitalized with oncologic sequelae, diagnoses including advanced disease that may capture the effects of unmanaged or poorly managed cancer. Inpatient mortality was equivalent for only the most severely ill. Otherwise, the odds of inpatient mortality were 59% to 98% higher for blacks than whites. Treatment, in terms of procedure type, was equivalent for only the sickest patients. Among the less severely ill, blacks were less likely than whites to receive major therapeutic procedures.

“Multiple findings suggest that blacks with colorectal cancer were hospitalized with more severe conditions and treated less aggressively than whites. In an era of health-care reform, such differences, which are net of insurance effects, may require more than universal insurance coverage to be overcome.”

Multivariate analyses found that “...Blacks were more likely than whites to be hospitalized with nutritional problems and oncologic emergencies compared with primary tumor, whether metastases was recorded or not. In addition, among patients with metastases recorded, blacks were more likely than whites to be hospitalized with complications of progression (OR=1.451; P<0.05) and complications of radiation or chemotherapy (OR=1.505; P<0.01).”

“Blacks and whites differed in their odds of inpatient death for the primary tumor and oncologic sequelae subgroups. Among discharges without metastases, blacks were nearly twice as likely to die in the hospital with primary tumor and 1.7 times more likely to die in the hospital with oncologic sequelae. For discharges with primary tumor and metastasis, blacks were 1.6 times more likely as whites to die in the hospital….

“Blacks with primary tumor and no evidence of oncologic sequelae were significantly less likely than whites to receive a major procedure aimed at treatment of colorectal cancer. Compared with whites with primary tumor, blacks were 27% less likely to receive a major colorectal therapeutic procedure OR=0.590; P<0.001) when no metastasis was recorded. Compared with whites with primary tumor, blacks were 27% less likely to receive a major colorectal procedure (OR=0.726; P<0.05) when metastatis was recorded.”

“In summary, these findings suggest that blacks with colorectal cancer were hospitalized with more severe conditions and treated less aggressively. Whereas any one of these findings of this analysis could be attributed to some unmeasured factor, taken together they suggest differences in clinical management of blacks and whites hospitalized with one of the most common of cancers. The extent to which such differences are cultural, social, or economic cannot be determined with these data. However, because the differences found here were net of insurance effects, recognition of such differences may be important in designing a health reform model than ensures universal access and equitable treatment.”