Abstract
Introduction: Resection of colorectal liver metastases (CRLM) is associated with improved overall survival compared to palliative chemotherapy. Prior literature has demonstrated that Black patients are less likely to undergo surgical treatment compared to other races. However, little is known about the impact of health insurance on racial disparities. Aim of this study was to evaluate the effect of health insurance status on racial disparities in receipt of surgical therapy in patients with CRLM. Method: A retrospective cohort study of patients diagnosed with stage IV colorectal cancer with isolated CRLM was performed using the National Cancer Database (NCDB) (2006-2016). Primary outcome was receipt of surgical therapy for CRLM. Multivariable logistic regression (MVR) was performed to evaluate the association of race and health insurance with surgical resection. Results: A total of 6,002 patients were included: 70.5% White, 16.7% Black, 6.6% Hispanic, and 6.2% Other race. Rates of resection, systemic chemotherapy, and multimodality therapy were lower among Black compared to White patients. By MVR, Black patients had lower odds of liver resection compared to White patients. Uninsured patients were also less likely to undergo resection compared to patients with private insurance. On MVR of race stratified by health insurance, only Black patients with Medicare had decreased odds of undergoing liver resection compared to White patients. [Table] Conclusions: Black patients with CRLM have lower odds of liver resection compared to White patients, particularly among the Medicare-insured population. Further investigation is warranted to better understand racial disparities and develop implementation strategies to address them.Tabled 1Race (ref=White)Insurance StatusReceipt of ResectionOdds RatioReceipt of Resection95% Confidence IntervalBlackPrivate/Managed Care0.960.73-1.27Uninsured1.620.66-3.97Medicare0.550.38-0.78Medicaid0.840.52-1.38HispanicPrivate/Managed Care1.000.67-1.50Uninsured1.960.78-4.91Medicare0.700.39-1.25Medicaid0.910.49-1.71 Open table in a new tab
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