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Disparities in Colon Cancer Presentation and In-Hospital Mortality in Maryland: A Ten-Year Review

Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA

Correspondence: Address correspondence and reprint requests to: Susan L. Gearhart, MD; E-mail: sdemees1{at}jhmi.edu

Background: Much attention has focused on in-hospital treatment disparities in colon cancer outcomes. Little is known about the effect of prehospital factors on outcomes. We hypothesized that racial and socioeconomic disparities exist in the presentation of colon cancer and that these disparities affect in-hospital outcomes.

Methods: Ten-year data on colon cancer patients were obtained from the Maryland Hospital Discharge Database. Life-threatening symptoms at presentation served as a proxy for delay in diagnosis. Patients with the primary diagnosis of colon cancer treated with surgical resection were included. Outcomes of interest were obstruction, hemorrhage, perforation, and in-hospital mortality.

Results: A total of 14,291 patients had primary colon cancer, and 13,031 underwent resection. Among this group, 52% were male, 22% were African American (AA), and mean age of AA was 66.0 years versus non-AA mean age of 70.5 years (P < .001). Overall, 27.6% of patients presented with life-threatening symptoms. In-hospital mortality rate was 3.8%. Symptomatic patients had a 2-fold higher rate of in-hospital mortality (odds ratio [OR], 6.06 vs. 2.89, P < .001). Multivariate analysis demonstrated that AA were more likely to have life-threatening symptoms at presentation independent of socioeconomic status (SES) (OR, 1.36). In addition, AA had a higher in-hospital mortality, both overall (OR, 1.39) and in the higher SES (OR, 1.81).

Conclusions: Racial disparities exist in the rate of presentation with life-threatening symptoms that may be a proxy for a delay in diagnosis. These findings were independent of SES, implying that factors beyond health care access may account for poorer outcomes among AA.

Key Words: Colon cancer • Presentation • African American • Surgery