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

Abstract

Objective: To compare access, quality, and clinical outcomes between Latino and non-Latino White Californians with colon cancer.

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.