Disparities in colorectal cancer time-to-treatment and survival time associated with racial and economic residential segregation surrounding the diagnostic hospital, Georgia 2010–2015

• Published in: Cancer epidemiology Vol. 81; p. 102267
• Main Authors: Leslie, Timothy F., Frankenfeld, Cara L., Menon, Nirup
• Format: Journal Article
• Language: English
• Published: New York Elsevier Ltd 01.12.2022; Elsevier Limited
• Subjects: Cancer; Census; Chemotherapy; Clinical outcomes; Colorectal cancer; Colorectal carcinoma; Diagnosis; Economic models; Epidemiology; Evaluation; Geography; Georgia; Hispanic Americans; Hospital; Hospitals; Income; Medical diagnosis; Neighborhoods; Patients; Race; Segregation; Spatial data; Statistical models; Survival; Tumors; United States > US; Georgia; Hospital; Diagnosis; Georgia; Segregation; Colorectal cancer
• ISSN: 1877-7821; 1877-783X
• DOI: 10.1016/j.canep.2022.102267

To evaluate patient-level colorectal cancer outcomes in relation to residential income and racial segregation and composition of the neighborhood surrounding the diagnosing hospitals, and characterize presence of cancer-relevant diagnosis and treatment modalities that might contribute to these associations. We utilized Georgia state cancer registry data (2010–2015), matching diagnosis information to hospital technology provided by the American Hospital Association and spatial information to the US Census. We modeled time-to-treatment and survival time, using Cox proportional hazards models, stratified by segregation. Segregation was examined as residential economic and racial evenness (Atkinson index) and isolation (isolation index) and mean income at the Census tract level. To assess possible contributing factors, analysis of hospital diagnosis and treatment technologies in relation to segregation was conducted. Average income of the Census tract and racial residential segregation of the diagnosing hospital’s neighborhood was generally unassociated with time-to-treatment or survival time. Higher income evenness around the diagnosing hospital was associated with shorter time-to-treatment, with no association with time-to-death. Higher income isolation for the diagnosing hospital, conversely, was associated with longer times to treatment, but also longer survival times. Hospitals in regions with higher level of residential income segregation were less likely to have a particular diagnosing or treatment technologies, such as virtual colonoscopy and chemotherapy. Hospital resources may be a function of their immediate economic environment, and this may have influence on cancer outcomes. Future work should evaluate patient outcomes in light of technologies or therapies utilized within particular economic environments. •Residential segregation is a community feature that may influence hospital services.•Impact of residential segregation of hospitals for patient outcomes is not well known.•Oncology technologies were more available in lower segregation settings.•CRC patients diagnosed in more economically segregated hospitals had longer time-to-treatment.•CRC patients diagnosed in more economically segregated hospitals had longer survival.