Racial Differences in the Receipt of Bowel Surveillance Following Potentially Curative Colorectal Cancer Surgery

Macro International, QRC Division, Bethesda, MD 20814-3202, USA.
Health Services Research (Impact Factor: 2.78). 01/2004; 38(6 Pt 2):1885-903. DOI: 10.1111/j.1475-6773.2003.00207.x
Source: PubMed


To investigate racial differences in posttreatment bowel surveillance after colorectal cancer surgery in a large population of Medicare patients.
We used a large population-based dataset: Surveillance, Epidemiology, and End Results (SEER) linked to Medicare data.
This is a retrospective cohort study. We analyzed data from 44,768 non-Hispanic white, 2,921 black, and 4,416 patients from other racial/ethnic groups, aged 65 and older at diagnosis, who had a diagnosis of local or regional colorectal cancer between 1986 and 1996, and were followed through December 31, 1998. Cox Proportional Hazards models were used to investigate the relation of race and receipt of posttreatment bowel surveillance.
Sociodemographic, hospital, and clinical characteristics were collected at the time of diagnosis for all members of the cohort. Surgery and bowel surveillance with colonoscopy, sigmoidoscopy, and barium enema were obtained from Medicare claims using ICD-9-CM and CPT-4 codes.
The chance of surveillance within 18 months of surgery was 57 percent, 48 percent, and 45 percent for non-Hispanic whites, blacks, and others, respectively. After adjusting for sociodemographic, hospital, and clinical characteristics, blacks were 25 percent less likely than whites to receive surveillance if diagnosed between 1991 and 1996 (RR = 0.75, 95 percent CI = 0.70-0.81).
Elderly blacks were less likely than non-Hispanic whites to receive posttreatment bowel surveillance and this result was not explained by measured racial differences in sociodemographic, hospital, and clinical characteristics. More research is needed to explore the influences of patient- and provider-level factors on racial differences in posttreatment bowel surveillance.

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Available from: Kevin Knopf, Jul 09, 2014
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    • "The majority of the evidence regarding ethnicity and uptake of follow-up surveillance found that white CSs were more likely to receive follow-up screening [25,27,28,30,32,33] and to adhere to the guidelines specified above [31] than CSs of other ethnicities. A study based at a ‘safety-net hospital’ which provided care to underserved populations such as ethnic minorities found that black colorectal CSs were more likely to receive follow-up colonoscopies within 3-years of curative resection than CSs of other ethnicities [34]. "
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    • "Second, these studies have included only patients from restricted age and insurance groups (e.g., Medicare recipients), clinic-based populations, or regional health systems[12-18,21]. Finally, previous studies have been limited to administrative data [12,13,16,17,20,21], which may not capture important details about survivors' clinical characteristics. "
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