529 Background: Colorectal cancer is the fourth most common cancer in the United states and the second most common cause of death. Despite universal advocacy for screening colonoscopies and early diagnosis, racial disparities in screening and diagnosis of colorectal cancer exist and affect patients outcomes. In this analysis we determine racial disparities and treatment outcomes for colorectal cancer treatment in the United States. Methods: We performed a retrospective analysis of the National Inpatient Sample 2014 Database (HCUP_NIS) which contains records of all hospital discharges in the United States Patients 18 years and older with a diagnosis of colorectal cancer were identified by their ICD 9 codes along with treatment they had for colorectal cancer. We then used multivariable regression to identify the effect of race on receiving a therapeutic procedure (open surgical, laparoscopic or robotic) during hospitalization and outcomes as it relates to inpatient mortality. We adjusted for patients age, sex, number of comorbidities (elixhauser comorbidity score), insurance type, and hospital level charactertistics (i.e. size, teaching status) and location (urban and rural location). Results: There were 25,749 discharge diagnosis of colorectal cancer in the United States in 2014 of which 19,300 were associated with undergoing a procedure for colorectal cancer treatment. Whites accounted for the majority of colorectal cancer admissions (65%) while blacks 11.4 %, Hispanics 8.0%, Asian/Pacific Islanders 3.2 %, and Native Americans 0.4%. Blacks had the lowest frequency of procedure related admissions and were less likely to undergo a therapeutic procedure relating to colorectal cancer treatment (67.5 vs. 76.6 OR 0.84 CI 0.75 - 0.93) compared to whites. For specific procedures, blacks (OR 0.81, CI 0.72-0.91) and Hispanics (OR 0.85, CI 0.74-0.98) had a significantly lesser odds of undergoing open surgical procedures when compared to whites but were similarly likely (Blacks OR 0.93, CI 0.81-1.05, Hispanics OR 0.84, CI 0.61-1.14) to undergo laparoscopic/robotic surgical procedure. On multivariable analysis, Asian/Pacific Islanders had a significantly higher mortality (OR 1.61 CI 1.01-2.60) for non-procedure related colorectal cancer admissions. However, this increase mortality was not seen in procedure related colorectal cancer admissions. Overall, after adjusting for potential confounders and treatment, there was no significant variation amongst different races for colorectal cancer mortality in patients admitted to the hospital. Conclusions: Among patients with colorectal cancer there was no procedure related mortality differences between various races. However, for some reason Asian/Pacific Islanders had a significantly higher mortality for non-procedure related colorectal cancer admissions. Further studies are warranted to understand the above findings.
Analysis of Clinical and Economic Implications of Esmo 2014 Clinical Practice Guidelines for Metastatic Colorectal Cancer Treatment