Influence of Race, Insurance, Rurality, and Socioeconomic Status on Equity of Lung and Colorectal Cancer Care.

Abstract

This study evaluated the influence that social determinants of health had on stage at diagnosis and receipt of cancer-directed surgery for patients with lung and colorectal cancer in the North Carolina Central Cancer Registry (2010-2015). This study examined non-Hispanic uninsured or privately-insured patients 18 to 64 years of age. Multivariable logistic regression models, including two-way interaction terms, assessed the influence of race, insurance status, rurality, and Social Deprivation Index on stage at diagnosis and receipt of surgery. 6574 lung cancer patients and 5355 colorectal cancer patientswere included. Among the lung cancer patients, the uninsured patients had higher odds of having stage IV disease (odds ratio [OR]=1.46; 95 % confidence interval [CI]=1.22-1.76) and lower odds of receiving surgery (OR=0.48; 95 % CI=0.34-0.69) than the privately-insured patients. Among the colorectal cancer patients, uninsured status was associated with higher odds of stage IV disease (OR=1.53; 95 % CI=1.17-2.00) than privately-insured status. A significant insurance status and rurality interaction (p = 0.03) was found in the colorectal model for receipt of surgery. In the privately-insured group, non-Hispanic Black and rural patients had lower odds of receiving colorectal surgery (OR=0.69; 95 % CI= 0.50-0.94 and OR= 0.68; 95 % CI= 0.52-0.89; respectively) than their non-Hispanic White and urban counterparts. After controlling for confounding and evaluation of interactions between patient-, community-, and geographic-level factors, uninsured status remained the strongest driver of patients' presentation with late-stage lung and colorectal cancer. As policy and care delivery transformation targets uninsured and vulnerable populations, explicit recognition, and measurement of intersectionality should be considered.