Purpose

Research has shown that racial/ethnic disparities exist in outcomes for colorectal cancer (CRC) patients, but there are no studies assessing inpatient palliative care utilization and hospitalization outcomes in this population. We examined racial/ethnic disparities in palliative care utilization and hospitalization outcomes among CRC and early-onset CRC patients.

Methods

Using National Inpatient Sample (NIS) data collected between 2016 and 2018, cross-sectional analyses were performed. Descriptive analyses were done, stratified by race/ethnicity. Multivariable logistic and linear regression models were used to examine racial/ethnic differences in palliative care utilization, inpatient mortality, chemotherapy/radiotherapy use, length of stay and total hospital charges among hospitalized patients with CRC and early-onset CRC.

Results

Blacks had higher odds (AOR: 1.09; 95% CI: 1.03–1.16) of receiving palliative care consultation while Hispanics had lower odds (AOR: 0.90; 95% CI: 0.84–0.96) compared to Whites. Blacks had 1.1 times higher odds (95% CI: 1.01–1.18) of inpatient mortality relative to Whites while Hispanics had 16% (AOR: 0.84; 95% CI: 0.76–0.93) lower odds of inpatient mortality. Compared to Whites, Blacks (AOR: 1.99; 95% CI: 1.64–2.41), Hispanics (AOR: 2.49; 95% CI: 1.94–3.19) and colorectal cancer patients in the other category (AOR: 1.72; 95% CI: 1.35–2.18) were more likely to receive inpatient treatment with chemotherapy/radiotherapy. Furthermore, Black patients were 1.1 times (95% CI: 1.06–1.14) more likely to have a length of stay more than 5 days. Blacks (𝛃: $3,096.7; 95% CI: $1,207.0–$4,986.5) Hispanic (𝛃: $10,237.5; 95% CI: $7,558.2–$12,916.8) and other patients (𝛃: $6,332.0; 95% CI: $2,830.9–$9, 833.2) had higher hospital charges relative to their White counterparts. Among patients with early onset CRC, Blacks had higher palliative care use (AOR: 1.29; 95% CI: 1.10–1.51) and inpatient mortality (AOR: 1.38; 95% CI: 1.06–1.79) while Hispanics reported $5,589.7 (95% CI: $683.2–$10,496.2) higher total hospital charges and were more likely to receive inpatient chemotherapy/radiotherapy (AOR: 2.48; 95% CI: 1.70–3.63).

Conclusion

Further research is needed to explore specific cultural, socioeconomic, and political factors that explain these disparities and identify ways to narrow the gap. Meanwhile, the healthcare sector will need to assess what strategies might be helpful in addressing these disparities in outcomes in the context of other socioeconomic and cultural factors that may be affecting the patients.

中文翻译：

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结直肠癌患者住院姑息治疗利用和住院结果的种族/民族差异

目的

研究表明，结直肠癌 (CRC) 患者的结局存在种族/民族差异，但尚无研究评估该人群住院姑息治疗的利用和住院结局。我们研究了结直肠癌和早发结直肠癌患者在姑息治疗利用和住院结果方面的种族/民族差异。

方法

使用 2016 年至 2018 年期间收集的全国住院患者样本 (NIS) 数据进行横断面分析。进行了描述性分析，按种族/民族分层。使用多变量逻辑回归和线性回归模型来检查住院 CRC 和早发性 CRC 患者在姑息治疗利用率、住院患者死亡率、化疗/放疗使用、住院时间和总住院费用方面的种族/民族差异。

结果

与白人相比，黑人接受姑息治疗咨询的几率较高（AOR：1.09；95% CI：1.03-1.16），而西班牙裔接受姑息治疗的几率较低（AOR：0.90；95% CI：0.84-0.96）。黑人的住院死亡率比白人高 1.1 倍（95% CI：1.01–1.18），而西班牙裔的住院死亡率比白人低 16%（AOR：0.84；95% CI：0.76–0.93）。与白人相比，黑人（AOR：1.99；95% CI：1.64–2.41）、西班牙裔（AOR：2.49；95% CI：1.94–3.19）和另一类结直肠癌患者（AOR：1.72；95% CI： 1.35–2.18）更有可能接受化疗/放疗住院治疗。此外，黑人患者住院时间超过 5 天的可能性是黑人患者的 1.1 倍（95% CI：1.06-1.14）。黑人 (𝛃: $3,096.7; 95% CI: $1,207.0–$4,986.5) 西班牙裔 (𝛃: $10,237.5; 95% CI: $7,558.2–$12,916.8) 和其他患者 (𝛃: $6,332.0; 95% CI: $2,830.9–$9, 83 3.2）住院费用较高相对于他们的白人同行。在早发 CRC 患者中，黑人的姑息治疗使用率较高（AOR：1.29；95% CI：1.10–1.51），住院患者死亡率较高（AOR：1.38；95% CI：1.06–1.79），而西班牙裔则为 5,589.7 美元（95% CI：1.10–1.79）。 ：$683.2–$10,496.2）住院总费用较高，并且更有可能接受住院化疗/放疗（AOR：2.48；95% CI：1.70–3.63）。

结论

需要进一步研究来探索解释这些差异的具体文化、社会经济和政治因素，并找出缩小差距的方法。与此同时，医疗保健部门需要评估在可能影响患者的其他社会经济和文化因素的背景下，哪些策略可能有助于解决这些结果差异。