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Examining the Role of Access to Care: Racial/Ethnic Differences in Receipt of Resection for Early-Stage Non-Small Cell Lung Cancer among Integrated System Members and Non-Members
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11 2018
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Source: Lung Cancer. 125:51-56
[PDF-156.74 KB]
Details:
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Alternative Title:Lung Cancer
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Personal Author:
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Description:Objectives:
To examine the role of uniform access to care in reducing racial/ethnic disparities in receipt of resection for early stage non-small cell lung cancer (NSCLC) by comparing integrated health system member patients to demographically similar non-member patients.
Materials and Methods:
Using data from the California Cancer Registry, we conducted a retrospective cohort study of patients from four racial/ethnic groups (White, Black, Hispanic, Asian/Pacific Islander), aged 21 to 80, with a first primary diagnosis of stage I or II NSCLC between 2004 and 2011, in counties served by Kaiser Permanente Northern California (KPNC) at diagnosis. Our cohort included 1,565 KPNC member and 4,221 non-member patients. To examine the relationship between race/ethnicity and receipt of surgery stratified by KPNC membership, we used modified Poisson regression to calculate risk ratios (RR) adjusted for patient demographic and tumor characteristics.
Results:
Black patients were least likely to receive surgery regardless of access to integrated care (64–65% in both groups). The magnitude of the black-white difference in the likelihood of surgery receipt was similar for members (RR: 0.82, 95% CI: 0.73–0.93) and non-members (RR: 0.86, 95% CI: 0.80–0.94). Among members, roughly equal proportions of Hispanic and White patients received surgery; however, among non-members, Hispanic patients were less likely to receive surgery (non-members, RR: 0.93, 95% CI: 0.86–1.00; members, RR: 0.98, 95% CI: 0.89–1.08).
Conclusion:
Disparities in surgical treatment for NSCLC were not reduced through integrated health system membership, suggesting that factors other than access to care (e.g., patient-provider communication) may underlie disparities. Future research should focus on identifying such modifiable factors.
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Pubmed ID:30429038
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Pubmed Central ID:PMC6242353
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