Racial Segregation Among Patients with Cholangiocarcinoma—Impact on Diagnosis, Treatment, and Outcomes

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Annals of Surgical Oncology


Background: Racial segregation, an effect of historical marginalization, may impact cancer care and outcomes. We sought to examine the impact of racial segregation on the diagnosis, treatment, and outcomes of patients with cholangiocarcinoma (CCA). Patients and Methods: Data on Black and White patients with CCA were obtained from the linked SEER-Medicare database (2004–2015) and 2010 Census data. The index of dissimilarity (IoD), a validated measure of segregation, was used to assess Black–White disparities in stage disease presentation, surgery for localized disease, and cancer-specific mortality. Multivariable Poisson regression was performed, and competing risk regression analysis was used to determine cancer-specific survival. Results: Among 7480 patients with CCA, 90.2% (n = 6748) were White and 9.8% (n = 732) were Black. Overall, Black patients were more likely to reside in segregated areas compared with White patients (IoD, 0.42 vs. 0.38; p < 0.05). On multivariable Poisson regression, Black patients were more likely to present with advanced-stage disease [relative risk (RR) 1.17, 95% confidence interval (CI) 1.08–1.27; p < 0.001] and were less likely to undergo surgery for localized disease (RR 0.62, 95% CI 0.51–0.76; p < 0.001). Black patients also had worse cancer-specific survival (CSS) compared with White patients (median CSS: 4 vs. 8 months; p < 0.01). Black patients living in the highest areas of segregation had 40% increased hazard of mortality versus White patients residing in the lowest IoD areas (hazard ratio 1.40, 95% CI 1.10–1.80; p < 0.01). Conclusion: Racial segregation, as a proxy for structural racism, had a marked effect on Black–White disparities among patients with CCA.



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