February 18, 2016 | by Letisia Marquez
A person’s wealth can dramatically impact racial disparities in esophageal surgery outcomes, according to a new study led by City of Hope’s Loretta Erhunmwunsee, M.D., assistant professor in the Division of Thoracic Surgery.
The study confirms previous findings of low survival rates for blacks after an esophageal cancer diagnosis, with black patients surviving an average of 33 months after surgery compared to 46 months for whites. Those odds change once income i considered, with survival for both low-income groups slightly shorter – 26 months for blacks and 40 months for whites. Those racial disparities, however, reverse at higher income levels.
The study – which Erhunmwunsee led while in her previous position at Duke University Health System – analyzed data from the National Cancer Data Base. Researchers studied 6,147 esophageal cancer patients who underwent surgery. Of those, 293 patients, or 5 percent, were black.
Here, Erhunmwunsee answers questions about the findings, which were recently released at The Society of Thoracic Surgeons’ annual conference.
1. Why do poor patients have lower survival rates for esophageal cancer than more affluent patients?
Poor patients’ access to health care is different than patients with higher incomes. For one, they are less likely to undergo curative surgery. Also, the hospitals they access in their neighborhoods may be of poorer quality. They are more likely working in low-wage jobs that don’t provide them with the leeway to go for medical appointments that professional-level jobs do. Or they may have several jobs to help support their family and may worry that taking time off for their health will bring less money in for the family. And poor patients smoke more, exercise less, have poor eating habits and are exposed to more violence, which all have a negative health impact. The fact is low-income people have poor health so our goal is to figure out why in upcoming studies.
2. What did your study find about survival rates among black and white patients in the two highest income brackets?
Median survival in the higher income groups was 61 months for blacks and 52 months for whites. The fact that blacks in the highest income bracket did as well as whites in the same group suggests that socioeconomic status plays a big role in racial health disparities.
3. What do you hope the medical community takes away from this study?
Our study shows that in regard to esophageal cancer surgery, black patients are most vulnerable when they are poor and that they may actually be protected when they have higher socioeconomic status. These findings suggest that targeting socioeconomic differences will help combat these racial disparities. Being aware of the factors that are linked to higher death rates can empower patients to be more active with their own health and medical care. We hope that awareness of the problem among physicians and patients alike will lead to more public and professional focus on solving this disparity. Strategies could focus on new health policies that take into account socioeconomic disparities and help eradicate any unfair practices by health systems.
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