Disparities in Access, Quality, and Clinical Outcome for Latino Californians With Colon Cancer.

Abstract

To compare access, quality, and clinical outcomes between Latino and non-Latino White Californians with colon cancer. Racial and ethnic disparities in cancer care remain understudied, particularly among patients who identify as Latino. Exploring potential mechanisms, including differential utilization of high-volume hospitals, is an essential first step to designing evidence-based policy solutions. We identified all adults diagnosed with colon cancer between January 1, 2010 and December 31, 2020 from a statewide cancer registry linked to hospital administrative records. We compared survival, access (stage at diagnosis, receipt of surgical care, treatment at a high-volume hospital), and quality of care (receipt of adjuvant chemotherapy and adequacy of lymph node resection) between patients who identified as Latino and non-Latino White. A total of 75,543 patients met inclusion criteria, including 16,071 patients who identified as Latino (21.3%). Latino patients were significantly less likely to undergo definitive surgical resection [marginal difference (MD): -0.72 percentage points, 95% CI: -1.19, -0.26], have an operation in a timely manner (MD: -3.24 percentage points, 95% CI: -4.16, -2.32), or have an adequate lymphadenectomy (MD: -2.85 percentage points, 95% CI: -3.59, -2.12) even after adjustment for clinical and sociodemographic factors. Latino patients treated at high-volume hospitals were significantly less likely to die and more likely to meet access and quality metrics. Latino patients with colon cancer experienced delays, segregation, and lower receipt of recommended care. Hospital-level colectomy volume appears to be strongly associated with access, quality, and survival-especially for patients who identify as Latino-suggesting that directing at-risk patients with cancer to high-volume hospitals may improve health equity.