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

Check, Devon K.; Albers, Kathleen B.; Uppal, Kanti M.; Suga, Jennifer Marie; Adams, Alyce S.; Habel, Laurel A.; Quesenberry, Charles P.; Sakoda, Lori C.

doi:10.1016/j.lungcan.2018.09.006

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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

Published Date:

Sep 11 2018

Source:

Lung Cancer. 125:51-56.

Language:

English

Public Access Version Available on: November 01, 2019

Please check back on the date listed above.

Details:

Personal Authors:

Check, Devon K. ; Albers, Kathleen B. ; Uppal, Kanti M. ; Suga, Jennifer Marie ; Adams, Alyce S. ; ... More ▼

Keywords:

[+]

Pubmed ID:

30429038

Pubmed Central ID:

PMC6242353

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.

Document Type:

Journal Article

Collection(s):

CDC Public Access

Funding:

HHSN261201000140C/CA/NCI NIH HHS/United States
HHSN261201000035C/CA/NCI NIH HHS/United States
U24 CA171524/CA/NCI NIH HHS/United States
HHSN261201000035I/CA/NCI NIH HHS/United States
HHSN261201000034C/CA/NCI NIH HHS/United States
K07 CA188142/CA/NCI NIH HHS/United States
U58 DP003862/DP/NCCDPHP CDC HHS/United States

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