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. (November 2018)

• Record Type: Journal Article
• Authors: Check, Devon K.; Albers, Kathleen B.; Uppal, Kanti M.; Suga, Jennifer Marie; Adams, Alyce S.; Habel, Laurel A.; Quesenberry, Charles P.; Sakoda, Lori C.
• Is Part Of: Lung cancer. Volume 125(2018)
• Page Start: 51
• Page End: 56
• Publication Date: 2018-11
• Subjects: Cancer care -- Access to care -- Disparities; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2018.09.006
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: Regardless of care setting, black patients were least likely to receive surgery. Black-white differences were similar in integrated and non-integrated settings. With integrated care, surgery receipt was similar in Hispanic and white patients. With non-integrated care, surgery was slightly less common in Hispanic patients. Asian and white patients were equally likely to receive surgery in both settings. Abstract: 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 21–80, 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 1565 KPNC member and 4221 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.