Disparities in esophageal cancer care based on race: A National Cancer Database analysis

Ikenna C. Okereke, Jordan Westra, Douglas Tyler, Suzanne Klimberg, Daniel Jupiter, Rohit Venkatesan, Kaelyn Brooks, Yong Fang Kuo

Research output: Contribution to journalArticlepeer-review

Abstract

Esophageal cancer is one of the most common cancer killers in our country. The effects of racial disparities on care for esophageal cancer patients are incompletely understood. Using the National Cancer Database, we investigated racial disparities in treatment and outcome of esophageal cancer patients. The National Cancer Database was queried from 2004 to 2017. Logistic regression and survival analysis were used to determine racial differences in access, treatment and outcome. A total of 127,098 patients were included. All minority groups were more likely to be diagnosed at advanced stages versus Caucasians after adjusting for covariates (African American OR - 1.64 [95% confidence interval 1.53 - 1.76], Hispanic OR - 1.19 [1.08 - 1.32], Asian OR - 1.78 [1.55 - 2.06]). After adjustment, all minorities were less likely at every stage to receive surgery. Despite these disparities, Hispanics and Asians had improved survival compared with Caucasians. African Americans had worse survival. Racial disparities for receiving surgery were present in both academic and community institutions, and at high-volume and low-volume institutions. Surgery partially mediated the survival difference between African Americans and Caucasians (HR - 1.13 [1.10-1.16] and HR - 1.04 [1.02-1.07], without and with adjustment of surgery).There are racial disparities in the treatment of esophageal cancer. Despite these disparities, Hispanics and Asians have improved overall survival versus Caucasians. African Americans have the worst overall survival. Racial disparities likely affect outcome in esophageal cancer. But other factors, such as epigenetics and tumor biology, may correlate more strongly with outcome for patients with esophageal cancer.

Original languageEnglish (US)
Article numberdoab083
JournalDiseases of the Esophagus
Volume35
Issue number6
DOIs
StatePublished - Jun 1 2022

Keywords

  • cancer epidemiology
  • cancer treatment
  • esophageal cancer

ASJC Scopus subject areas

  • Gastroenterology

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