eP536 - Race-Based Healthcare Utilization Disparities in Colon Cancer in the State of New Jersey

Author(s)

• 

  Kayla N. Laraia

  Medical Student
  Rutgers - Robert Wood Johnson Medical School
  New Brunswick, NJ, United States

  Disclosure information not submitted.

ePoster Presenter(s)

• 

  Alexander J. Rossi, MD

  General Surgery Resident
  Rutgers Robert Wood Johnson Medical School
  Rutgers Robert Wood Johnson Medical School
  New Brunswick, NJ, United States

  Disclosure information not submitted.

Author(s)

• SA

  Sarfraz R. Akmal, n/a

  Medical Student
  Rutgers - Robert Wood Johnson Medical School
  New Brunswick, New Jersey, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• EK

  Emily Kolodka, M.D.

  General Surgery Resident
  Rutgers - Robert Wood Johnson Medical School
  New Brunswick, New Jersey, United States

  Disclosure information not submitted.
• LL

  Leonard Lee, M.D.

  Chairman, Department of Surgery
  Rutgers - Robert Wood Johnson Medical School
  New Brunswick, New Jersey, United States

  Disclosure information not submitted.
• BS

  Brendan Scully, MD

  Assistant Professor
  Rutgers Robert Wood Johnson Medical School
  New Brunswick, New Jersey, United States

  Disclosure information not submitted.
• DF

  Daniel Feingold, MD

  Professor of Surgery
  Rutgers University
  New Brunswick, New Jersey, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• KD

  Kristen Donohue, MD

  Assistant Professor of Surgery
  Rutgers RWJMS
  New Brunswick, New Jersey, United States

  Disclosure information not submitted.

Senior Author(s)

• NM

  Nell Maloney Patel, M.D.

  Program Director, General Surgery Residency
  Rutgers - Robert Wood Johnson Medical School
  New Brunswick, New Jersey, United States

  Disclosure information not submitted.

Purpose/Background: Race and socioeconomic status are well-described contributors to colon cancer incidence and outcomes due to complex socioeconomic and social determinants of health, including wealth, lifestyle factors, access to care, and screening and preventative health. Previous studies have investigated these associations on the national or single institution level, however, there is little investigation into the association between race and colon cancer care in distinct geographic regions. We sought to describe the status of colon cancer healthcare utilization within the state of New Jersey as regards racial and economic disparities, within the lens of inpatient stays.Methods/Interventions: The 2016-2019 New Jersey State Inpatient database was queried for patients with colon cancer (ICD-10-CM C18X). Patient demographics, including age, sex, race, zip-code-based income quartile, Charlson Comorbidity Index, and primary insurance were collected. Outcomes included length of hospital stay, total hospital charges, 7-day readmission, in-hospital mortality, metastatic cancer (locoregional or distant), pelvic abscesses, ileostomy, and colostomy creation rates. Characteristics and outcomes were compared using T-tests and Chi-squared tests. P < 0.05 was considered statistically significant.Results/Outcomes: A total of 20,346 patients were included in this analysis, 12,943 white and 7,403 non-white, of which 45.2% were Black, 32.1% were non-white Hispanic, and 10.0% were Asian/Pacific Islander. Of the non-white population, 73.8% identified English as their primary language. The non-white population was significantly younger (mean 65 years old) and poorer (47.5% in the second income quartile or lower), but less comorbid (CCI >4 in 64.4%). The non-White population had nearly double the incidence of early onset colon cancer (13.1% vs 5.8%). White patients had higher percentage of patients on Medicare (64.5% vs. 47.4%), while many non-White patients were uninsured or had another payment method (7.4% vs 2.4%). Non-white patients stayed in the hospital about half of one day longer than white patients (7.1 vs. 7.5 days) and had higher hospital charges by over $10,000. Non-white patients had higher rates of metastatic disease (52.7% vs. 44.0%). There were no significant differences in mortality rates, ileostomy creation rates or pelvic abscess rates. Colostomies were created significantly more often in the non-white population (5.5 vs. 4.7%).Conclusion/

Discussion: This state population-level data reveals that non-white patients with colon cancer are younger and less comorbid, yet have longer hospital stays, higher hospital costs, and a higher burden of disease. Lack of preventative healthcare and screening in this population may be leading to earlier onset and more aggressive disease at presentation. In order to appropriately care for this significant portion of the population, we must consider the unique factors contributing to these differences and address them on both the individual and systemic levels.Baseline characteristics and outcomes of inpatients with colon cancer in New Jersey from 2016 - 2019
Continuous variables are listed as mean and 95% confidence intervals. Categorical variables are listed as n (%). CCI Charlson Comorbidity Index. High CCI is CCI >4.