Can equitable care eliminate colon cancer disparities?

Abstract

91 Background: Previous studies suggest lack of insurance and variations in quality of care may drive disparities in colon cancer (CC), but equitable care may close these gaps. To clarify the role of equitable care on racial disparities, we compared CC survival in one of California’s largest Health Maintenance Organization (HMO) to survival in all other hospitals across the state. We hypothesized that disparities would be less pronounced in the HMO. Methods: All CC cases treated from 1996-2006 were identified in the California Cancer Registry linked to hospital discharge abstracts from the Office of Statewide Health Planning and Development. Enrollees in the state’s largest HMO were identified as such. Five year mortality was compared between HMO enrollees and all other patients using Cox proportional hazard models. Results: 62,184 CC records were included. 25% were HMO enrollees. The HMO treated a higher percent of black patients (9.2% versus 5.5%) and fewer Medicaid patients (2.1% versus 4.5%). There was no disparity in the HMO setting blacks as compared with whites (HR 0.90 95% CI 0.79-1.02); but black patients fared worse in the non-HMO settings (HR 1.15 95% CI 1.07-1.23). Conclusions: CC disparities are differentially distributed across California hospitals systems. Since there were no disparities in California’s large HMO, where care is typically protocol-driven, our findings suggest delivery of equitable care may eliminate disparities. These findings are consistent with other studies in the literature. Future research should assess the effect of emerging Accountable Care Organizations on the elimination of racial disparities in other cancers and diseases.