Health Care Access Dimensions and Racial Check for updates Disparities in End-of-Life Care Quality among Patients with Ovarian Cancer

Shama Karanth; Oyomoare L. Osazuwa-Peters; Lauren E. Wilson; Rebecca A. Previs; Fariha Rahman; Bin Huang; Maria Pisu; Margaret Liang; Kevin C. Ward; Maria J. Schymura; Andrew Berchuck; Tomi F. Akinyemiju

doi:10.1158/2767-9764.CRC-23-0283

Health Care Access Dimensions and Racial Check for updates Disparities in End-of-Life Care Quality among Patients with Ovarian Cancer

Shama Karanth
, Oyomoare L. Osazuwa-Peters
, Lauren E. Wilson
, Rebecca A. Previs
, Fariha Rahman
, Bin Huang
, Maria Pisu
, Margaret Liang
, Kevin C. Ward
, Maria J. Schymura
, Andrew Berchuck
, Tomi F. Akinyemiju

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

This study investigated the association between health care access (HCA) dimensions and racial disparities in end-of-life (EOL) care quality among non-Hispanic Black (NHB), non-Hispanic White (NHW), and Hispanic patients with ovarian cancer. This retrospective cohort study used the Surveillance, Epidemiology, and End Results–linked Medicare data for women diagnosed with ovarian cancer from 2008 to 2015, ages 65 years and older. Health care affordability, accessibility, and availability measures were assessed at the census tract or regional levels, and associations between these measures and quality of EOL care were examined using multivariable-adjusted regression models, as appropriate. The final sample included 4,646 women [mean age (SD), 77.5 (7.0) years]; 87.4% NHW, 6.9% NHB, and 5.7% Hispanic. In the multivariable-adjusted models, affordability was associated with a decreased risk of intensive care unit stay [adjusted relative risk (aRR) 0.90, 95% confidence interval (CI): 0.83–0.98] and in-hospital death (aRR 0.91, 95% CI: 0.84–0.98). After adjustment for HCA dimensions, NHB patients had lower-quality EOL care compared with NHW patients, defined as: increased risk of hospitalization in the last 30 days of life (aRR 1.16, 95% CI: 1.03–1.30), no hospice care (aRR 1.23, 95% CI: 1.04–1.44), in-hospital death (aRR 1.27, 95% CI: 1.03–1.57), and higher counts of poor-quality EOL care outcomes (count ratio:1.19, 95% CI: 1.04–1.36). HCA dimensions were strong predictors of EOL care quality; however, racial disparities persisted, suggesting that additional drivers of these disparities remain to be identified. Significance: Among patients with ovarian cancer, Black patients had lower-quality EOL care, even after adjusting for three structural barriers to HCA, namely affordability, availability, and accessibility. This suggests an important need to investigate the roles of yet unexplored barriers to HCA such as accommodation and acceptability, as drivers of poor-quality EOL care among Black patients with ovarian cancer.

Original language	English
Pages (from-to)	811-821
Number of pages	11
Journal	Cancer Research Communications
Volume	4
Issue number	3
DOIs	https://doi.org/10.1158/2767-9764.CRC-23-0283
State	Published - Mar 2024

Bibliographical note

Publisher Copyright:
© 2024 The Authors; Published by the American Association for Cancer Research.

Funding

The authors acknowledge the helpful assistance provided by the SEER-Medicare reviewers, Information Management System coordinator Elaine Yanisko, and all patients whose valuable data contributed to this study. In addition, “the collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 5NU58DP006344; the NCI’s SEER Program under contract HHSN261201800032I awarded to the University of California, San Francisco; contract HHSN261201800015I awarded to the University of Southern California; and contract HHSN261201800009I awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the State of California, Department of Public Health, the NCI, and the Centers for Disease Control and Prevention or their contractors and contractors.”

Funders	Funder number
Massachusetts Department for Public Health
University of Southern California
Centers for Disease Control and Prevention	5NU58DP006344
Centers for Disease Control and Prevention
National Childhood Cancer Registry – National Cancer Institute	HHSN261201800032I
National Childhood Cancer Registry – National Cancer Institute

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

ASJC Scopus subject areas

Oncology
Cancer Research

Access to Document

10.1158/2767-9764.CRC-23-0283

Cite this

Karanth, S., Osazuwa-Peters, O. L., Wilson, L. E., Previs, R. A., Rahman, F., Huang, B., Pisu, M., Liang, M., Ward, K. C., Schymura, M. J., Berchuck, A., & Akinyemiju, T. F. (2024). Health Care Access Dimensions and Racial Check for updates Disparities in End-of-Life Care Quality among Patients with Ovarian Cancer. Cancer Research Communications, 4(3), 811-821. https://doi.org/10.1158/2767-9764.CRC-23-0283

@article{078e51a8f9f842019dc642dd1515335f,

title = "Health Care Access Dimensions and Racial Check for updates Disparities in End-of-Life Care Quality among Patients with Ovarian Cancer",

abstract = "This study investigated the association between health care access (HCA) dimensions and racial disparities in end-of-life (EOL) care quality among non-Hispanic Black (NHB), non-Hispanic White (NHW), and Hispanic patients with ovarian cancer. This retrospective cohort study used the Surveillance, Epidemiology, and End Results–linked Medicare data for women diagnosed with ovarian cancer from 2008 to 2015, ages 65 years and older. Health care affordability, accessibility, and availability measures were assessed at the census tract or regional levels, and associations between these measures and quality of EOL care were examined using multivariable-adjusted regression models, as appropriate. The final sample included 4,646 women [mean age (SD), 77.5 (7.0) years]; 87.4\% NHW, 6.9\% NHB, and 5.7\% Hispanic. In the multivariable-adjusted models, affordability was associated with a decreased risk of intensive care unit stay [adjusted relative risk (aRR) 0.90, 95\% confidence interval (CI): 0.83–0.98] and in-hospital death (aRR 0.91, 95\% CI: 0.84–0.98). After adjustment for HCA dimensions, NHB patients had lower-quality EOL care compared with NHW patients, defined as: increased risk of hospitalization in the last 30 days of life (aRR 1.16, 95\% CI: 1.03–1.30), no hospice care (aRR 1.23, 95\% CI: 1.04–1.44), in-hospital death (aRR 1.27, 95\% CI: 1.03–1.57), and higher counts of poor-quality EOL care outcomes (count ratio:1.19, 95\% CI: 1.04–1.36). HCA dimensions were strong predictors of EOL care quality; however, racial disparities persisted, suggesting that additional drivers of these disparities remain to be identified. Significance: Among patients with ovarian cancer, Black patients had lower-quality EOL care, even after adjusting for three structural barriers to HCA, namely affordability, availability, and accessibility. This suggests an important need to investigate the roles of yet unexplored barriers to HCA such as accommodation and acceptability, as drivers of poor-quality EOL care among Black patients with ovarian cancer.",

author = "Shama Karanth and Osazuwa-Peters, \{Oyomoare L.\} and Wilson, \{Lauren E.\} and Previs, \{Rebecca A.\} and Fariha Rahman and Bin Huang and Maria Pisu and Margaret Liang and Ward, \{Kevin C.\} and Schymura, \{Maria J.\} and Andrew Berchuck and Akinyemiju, \{Tomi F.\}",

note = "Publisher Copyright: {\textcopyright} 2024 The Authors; Published by the American Association for Cancer Research.",

year = "2024",

month = mar,

doi = "10.1158/2767-9764.CRC-23-0283",

language = "English",

volume = "4",

pages = "811--821",

number = "3",

}

Karanth, S, Osazuwa-Peters, OL, Wilson, LE, Previs, RA, Rahman, F, Huang, B, Pisu, M, Liang, M, Ward, KC, Schymura, MJ, Berchuck, A & Akinyemiju, TF 2024, 'Health Care Access Dimensions and Racial Check for updates Disparities in End-of-Life Care Quality among Patients with Ovarian Cancer', Cancer Research Communications, vol. 4, no. 3, pp. 811-821. https://doi.org/10.1158/2767-9764.CRC-23-0283

TY - JOUR

T1 - Health Care Access Dimensions and Racial Check for updates Disparities in End-of-Life Care Quality among Patients with Ovarian Cancer

AU - Karanth, Shama

AU - Osazuwa-Peters, Oyomoare L.

AU - Wilson, Lauren E.

AU - Previs, Rebecca A.

AU - Rahman, Fariha

AU - Huang, Bin

AU - Pisu, Maria

AU - Liang, Margaret

AU - Ward, Kevin C.

AU - Schymura, Maria J.

AU - Berchuck, Andrew

AU - Akinyemiju, Tomi F.

PY - 2024/3

Y1 - 2024/3

N2 - This study investigated the association between health care access (HCA) dimensions and racial disparities in end-of-life (EOL) care quality among non-Hispanic Black (NHB), non-Hispanic White (NHW), and Hispanic patients with ovarian cancer. This retrospective cohort study used the Surveillance, Epidemiology, and End Results–linked Medicare data for women diagnosed with ovarian cancer from 2008 to 2015, ages 65 years and older. Health care affordability, accessibility, and availability measures were assessed at the census tract or regional levels, and associations between these measures and quality of EOL care were examined using multivariable-adjusted regression models, as appropriate. The final sample included 4,646 women [mean age (SD), 77.5 (7.0) years]; 87.4% NHW, 6.9% NHB, and 5.7% Hispanic. In the multivariable-adjusted models, affordability was associated with a decreased risk of intensive care unit stay [adjusted relative risk (aRR) 0.90, 95% confidence interval (CI): 0.83–0.98] and in-hospital death (aRR 0.91, 95% CI: 0.84–0.98). After adjustment for HCA dimensions, NHB patients had lower-quality EOL care compared with NHW patients, defined as: increased risk of hospitalization in the last 30 days of life (aRR 1.16, 95% CI: 1.03–1.30), no hospice care (aRR 1.23, 95% CI: 1.04–1.44), in-hospital death (aRR 1.27, 95% CI: 1.03–1.57), and higher counts of poor-quality EOL care outcomes (count ratio:1.19, 95% CI: 1.04–1.36). HCA dimensions were strong predictors of EOL care quality; however, racial disparities persisted, suggesting that additional drivers of these disparities remain to be identified. Significance: Among patients with ovarian cancer, Black patients had lower-quality EOL care, even after adjusting for three structural barriers to HCA, namely affordability, availability, and accessibility. This suggests an important need to investigate the roles of yet unexplored barriers to HCA such as accommodation and acceptability, as drivers of poor-quality EOL care among Black patients with ovarian cancer.

AB - This study investigated the association between health care access (HCA) dimensions and racial disparities in end-of-life (EOL) care quality among non-Hispanic Black (NHB), non-Hispanic White (NHW), and Hispanic patients with ovarian cancer. This retrospective cohort study used the Surveillance, Epidemiology, and End Results–linked Medicare data for women diagnosed with ovarian cancer from 2008 to 2015, ages 65 years and older. Health care affordability, accessibility, and availability measures were assessed at the census tract or regional levels, and associations between these measures and quality of EOL care were examined using multivariable-adjusted regression models, as appropriate. The final sample included 4,646 women [mean age (SD), 77.5 (7.0) years]; 87.4% NHW, 6.9% NHB, and 5.7% Hispanic. In the multivariable-adjusted models, affordability was associated with a decreased risk of intensive care unit stay [adjusted relative risk (aRR) 0.90, 95% confidence interval (CI): 0.83–0.98] and in-hospital death (aRR 0.91, 95% CI: 0.84–0.98). After adjustment for HCA dimensions, NHB patients had lower-quality EOL care compared with NHW patients, defined as: increased risk of hospitalization in the last 30 days of life (aRR 1.16, 95% CI: 1.03–1.30), no hospice care (aRR 1.23, 95% CI: 1.04–1.44), in-hospital death (aRR 1.27, 95% CI: 1.03–1.57), and higher counts of poor-quality EOL care outcomes (count ratio:1.19, 95% CI: 1.04–1.36). HCA dimensions were strong predictors of EOL care quality; however, racial disparities persisted, suggesting that additional drivers of these disparities remain to be identified. Significance: Among patients with ovarian cancer, Black patients had lower-quality EOL care, even after adjusting for three structural barriers to HCA, namely affordability, availability, and accessibility. This suggests an important need to investigate the roles of yet unexplored barriers to HCA such as accommodation and acceptability, as drivers of poor-quality EOL care among Black patients with ovarian cancer.

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UR - https://www.scopus.com/pages/publications/85195071923#tab=citedBy

U2 - 10.1158/2767-9764.CRC-23-0283

DO - 10.1158/2767-9764.CRC-23-0283

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AN - SCOPUS:85195071923

VL - 4

SP - 811

EP - 821

JO - Cancer Research Communications

JF - Cancer Research Communications

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ER -

Health Care Access Dimensions and Racial Check for updates Disparities in End-of-Life Care Quality among Patients with Ovarian Cancer

Abstract

Bibliographical note

Funding

UN SDGs

ASJC Scopus subject areas

Access to Document

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