Decreased Use of Sphincter-Preserving Procedures Among African Americans with Rectal Cancer
Improved multimodality rectal cancer treatment has increased the use of sphincter-preserving surgery. This study sought to determine whether African American (AA) patients with rectal cancer receive sphincter-preserving surgery at the same rate as non-AA patients.
The study used the Nationwide Inpatient Sample for years 1998–2012 to compare AA and non-AA patients with rectal cancer undergoing low anterior resection or abdominoperineal resection. The logistic regression model was used to adjust for age, gender, admission type, Elixhauser comorbidity index, and hospital factors such as size, location (urban vs.rural), teaching status, and procedure volume.
The search identified 22,697 patients, 1600 of whom were identified as AA. After adjustment for age and gender, the analysis showed that AA patients were less likely to undergo sphincter-preserving surgery than non-AA patients [odds ratio (OR) 0.70; 95% confidence interval (CI) 0.63–0.78; p < 0.0001). After further adjustment for the Elixhauser comorbidity index, admission type, hospital-specific factors, and insurance status, the analysis showed that AA patients still were less likely to undergo sphincter-preserving surgery (OR 0.78; 95% CI 0.70–0.87; p < 0.0001). Although the proportion of non-AA patients undergoing sphincter-preserving surgery increased during the study period (p = 0.0003), this trend was not significant for the AA patients (p = 0.13).
In this data analysis, the AA patients with rectal cancer had lower rates of sphincter-preserving surgery than the non-AA patients, even after adjustment for patient- and hospital-specific factors. Further work is required to elucidate why. Eliminating racial disparities in rectal cancer treatment should continue to be a priority for the surgical community.
This work was funded by the Center for Health African American Men through Partnerships (CHAAMPS). The research reported in this publication was supported by the National Institute of Minority Health and Health Disparities through a grant from the National Institutes of Health under Award No. U54MD008620. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
The authors have no commercial interests to disclose.
- 7.Agency for Healthcare Research & Quality (AHRQ) MD. R. HCUP Databases. Healthcare Cost & Utilization Project (HCUP). [Internet]. vol 2016. https://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 1 Apr 2016.
- 10.Ricciardi R, Virnig BA, Madoff RD, Rothenberger DA, Baxter NN. The status of radical proctectomy and sphincter-sparing surgery in the United states. Dis Colon Rectum. 2007;50:1117–9.Google Scholar