Racial Disparity In Surgery For Esophageal Cancer

Surgery for esophageal cancer (esophagectomy) is considered standard of care for patients with early-stage disease and can provide long-term survival benefits to the patients. These surgeries are fairly complex procedures and historically associated with high morbidity; however, treatment at specialized centers with a high volume of patients undergoing esophagectomy has been shown to result in significantly decreased rates of complications and death.

Despite the benefits of esophageal surgery, racial disparities have been observed in clinical outcomes among patients with esophageal cancer. Rehmani and colleagues hypothesized that racial disparities in access and utilization of specialized, high-volume hospitals can contribute to observed differences in survival outcomes between blacks and whites.

The researchers analyzed data on 2895 esophageal cancer patients in New York State who underwent surgical treatment between 1995 and 2012. The data was obtained from the New York Statewide Planning and Research Cooperative System (SPARCS) inpatient database maintained by the New York State (NYS) Department of Health. The database captures various population groups with diverse racial, ethnic, and socioeconomic backgrounds across various geographic settings including metropolitan, suburban, and rural areas of New York State.

The analysis revealed significant differences between black and white patients with regards to gender distribution, health insurance status, and income distribution. Black patients had a higher frequency of patients who were female, had Medicaid, and were within lower quartiles of median household income.

The two most important findings of the study were the decreased utilization of high-volume hospitals and increased in-hospital mortality among black patients. Black patients were more likely to utilize a low-volume center after adjusting for demographic and socioeconomic factors. An unexpected finding was that black patients were less likely to access a high-volume hospital despite living closer to one compared to white patients.

Considering the differences in demographics and hospital distribution in New York City compared to the rest of the state, the authors also performed a similar analysis of a subset of patients who resided in New York City and obtained similar results. The second important finding of the study was the increased in-hospital mortality rate among black patients.

Overall, blacks had a higher mortality rate compared to whites at both Low- and High-volume hospitals after adjusting for various factors and restricting the analysis to elective surgical cases only. The yearly trends of mortality from 1995 to 2012 showed a decrease in mortality rates for both blacks and whites but the rates continued to remain higher for black patients. The researchers also performed a similar analysis on a matched group of patients and observed similar findings.

These findings are described in the article entitled Racial Disparity in Utilization of High-Volume Hospitals for Surgical Treatment of Esophageal Cancer, recently published in the journal Annals of Thoracic Surgery. This work was conducted by Sadiq S. Rehmani, Bian Liu, Wissam Raad, Raja M. Flores, Faiz Bhora, and Emanuela Taioli from the Icahn School of Medicine at Mount Sinai, and Adnan M. Al-Ayoubi from the University of Iowa.