Socioeconomic determinants of the surgical treatment of colorectal liver metastases

Abstract

ObjectiveWe hypothesized that differences in resection rates of colorectal liver metastases exist based on socioeconomic status (SES) inequalities. MethodsThe NCDB was utilized to study patients of different median household income diagnosed with colon adenocarcinoma from 2010 to 2015. ResultsA total of 21,258 patients met inclusion criteria, of whom 3,587 (16.9%) underwent metastasectomy. Patients of the highest income quartile were more likely to undergo metastasectomy compared to the lowest quartile (OR 1.20, CI 1.07–1.37, p = 0.003). Overall, patients in the highest income quartile had a median OS of 17.1 months compared with 13.0 months for the lowest quartile (HR 0.85, CI 0.81–0.90, p < 0.001). While metastasectomy was associated with improved OS across all groups, the disparity by income quartile widened (29.2 vs. 22.0 months, respectively; HR 0.51, CI 0.49–0.54, p < 0.001). ConclusionHigher income patients were more likely to undergo metastasectomy compared with lower income patients and were associated with longer OS.