Racial/Ethnic Disparities in Mortality Related to Access to Care for Major Cancers in the United States

SIMPLE SUMMARY: The contribution of access to care to racial/ethnic disparities in cancer outcomes remains insufficiently investigated. Our study showed substantial racial/ethnic disparities in total mortality of the top five major cancers for U.S. men and women, across 4 major racial/ethnic populations. We found that the non-Hispanic (NH)-black and NH-white mortality disparity was most evident among patients with a high socioeconomic status (SES) or those who had private insurance, while the NH-white versus Hispanic and Asian disparities were more evident among patients with low SES, or those with no insurance or Medicare or Medicaid. Our findings highlight the need to develop racial/ethnic-specific strategies to reduce the disparity in mortality among cancer patients, and call for further investigation on factors other than access to care (e.g., lifestyle, treatment adherence, provider/patient relationships, etc.) for their contributions to the racial/ethnic disparities in cancer outcomes. ABSTRACT: Importance: The reasons underlying racial/ethnic mortality disparities for cancer patients remain poorly understood, especially regarding the role of access to care. Participants: Over five million patients with a primary diagnosis of lung, breast, prostate, colon/rectum, pancreas, ovary, or liver cancer during 2004–2014, were identified from the National Cancer Database. Cox proportional hazards models were applied to estimate hazard ratios (HR) and 95% confidence intervals (CI) for total mortality associated with race/ethnicity, and access to care related factors (i.e., socioeconomic status [SES], insurance, treating facility, and residential type) for each cancer. Results: Racial/ethnic disparities in total mortality were observed across seven cancers. Compared with non-Hispanic (NH)-white patients, NH-black patients with breast (HR = 1.27, 95% CI: 1.26 to 1.29), ovarian (HR = 1.20, 95% CI: 1.17 to 1.23), prostate (HR = 1.31, 95% CI: 1.30 to 1.33), colorectal (HR = 1.11, 95% CI: 1.10 to 1.12) or pancreatic (HR = 1.03, 95% CI: 1.02 to 1.05) cancers had significantly elevated mortality, while Asians (13–31%) and Hispanics (13–19%) had lower mortality for all cancers. Racial/ethnic disparities were observed across all strata of access to care related factors and modified by those factors. NH-black and NH-white disparities were most evident among patients with high SES or those with private insurance, while Hispanic/Asian versus NH-white disparities were more evident among patients with low SES or those with no/poor insurance. Conclusions and Relevance: Racial/ethnic mortality disparities for major cancers exist across all patient groups with different access to care levels. The influence of SES or insurance on mortality disparity follows different patterns for racial/ethnic minorities versus NH-whites. Impact: Our study highlights the need for racial/ethnic-specific strategies to reduce the mortality disparities for major cancers.