The Effect of Health Insurance on Racial Disparities in Patients With Isolated Colorectal Liver Metastases

Area of Science:

• Oncology
• Health Services Research
• Surgical Oncology

Background:

• Colorectal liver metastases (CRLM) significantly impact patient survival.
• Existing disparities in CRLM care are linked to patient race and health insurance status.
• Understanding these disparities is crucial for equitable treatment strategies.

Purpose of the Study:

• To investigate the influence of health insurance on racial disparities in the surgical resection of colorectal liver metastases (CRLM).
• To determine if insurance status modifies the association between race and CRLM resection rates.

Main Methods:

• Retrospective analysis of 44,616 patients with colorectal cancer and synchronous CRLM from the National Cancer Database (2004-2020).
• Primary outcome assessed was the rate of liver resection.
• Multivariable logistic regression was employed to analyze the association of race and insurance with resection odds.

Main Results:

• Overall CRLM resection rates were lower in Black patients (12.9%) compared to White patients (17.3%).
• Black patients, uninsured, and Medicaid-insured patients demonstrated significantly lower odds of undergoing resection compared to White and privately insured patients, respectively.
• When stratified by insurance, Black patients with private and Medicare insurance showed reduced odds of resection compared to their White counterparts.

Conclusions:

• Racial disparities in CRLM hepatic resection exist, with Black patients having lower odds.
• These disparities are particularly evident among Black patients with private and Medicare insurance.
• Further research is needed to identify underlying factors contributing to these observed racial disparities in CRLM treatment.