Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu).
J Public Health Manag Pract. 2022;28(2):E487-E496. doi: 10.1097/PHH.0000000000001341.
Colorectal cancer (CRC) surgical treatment delay (TD) has been associated with mortality and morbidity; however, disparities by TD profiles are unknown.
This study aimed to identify CRC patient profiles of surgical TD while accounting for differences in sociodemographic, health insurance, and geographic characteristics.
We used latent class analysis (LCA) on 2005-2015 Tennessee Cancer Registry data of CRC patients and observed indicators that included sex/gender, age at diagnosis, marital status (single/married/divorced/widowed), race (White/Black/other), health insurance type, and geographic residence (non-Appalachian/Appalachian).
The state of Tennessee in the United States that included both Appalachian and non-Appalachian counties.
Adult (18 years or older) CRC patients (N = 35 412) who were diagnosed and surgically treated for in situ (n = 1286) and malignant CRC (n = 34 126).
The distal outcome of TD was categorized as 30 days or less and more than 30 days from diagnosis to surgical treatment.
Our LCA identified a 4-class solution and a 3-class solution for in situ and malignant profiles, respectively. The highest in situ CRC patient risk profile was female, White, aged 75 to 84 years, widowed, and used public health insurance when compared with respective profiles. The highest malignant CRC patient risk profile was male, Black, both single/never married and divorced/separated, resided in non-Appalachian county, and used public health insurance when compared with respective profiles. The highest risk profiles of in situ and malignant patients had a TD likelihood of 19.3% and 29.4%, respectively.
While our findings are not meant for diagnostic purposes, we found that Blacks had lower TD with in situ CRC. The opposite was found in the malignant profiles where Blacks had the highest TD. Although TD is not a definitive marker of survival, we observed that non-Appalachian underserved/underrepresented groups were overrepresented in the highest TD profiles. The observed disparities could be indicative of intervenable risk.
结直肠癌（CRC）手术治疗延迟（TD）与死亡率和发病率有关；然而，TD 特征的差异尚不清楚。
本研究旨在确定 CRC 患者手术 TD 的特征，同时考虑到社会人口统计学、健康保险和地理特征的差异。
我们使用 2005-2015 年田纳西州癌症登记处 CRC 患者的数据进行潜在类别分析（LCA），并观察了包括性别/性别、诊断时的年龄、婚姻状况（单身/已婚/离婚/丧偶）、种族（白种人/黑种人/其他）、健康保险类型和地理居住（非阿巴拉契亚/阿巴拉契亚）在内的指标。
美国田纳西州，包括阿巴拉契亚和非阿巴拉契亚县。
年龄在 18 岁或以上的 CRC 患者（n = 35412），这些患者被诊断为原位（n = 1286）和恶性 CRC（n = 34126），并接受了手术治疗。
TD 的远端结果分为诊断后 30 天或更短时间和 30 天以上进行手术治疗。
我们的 LCA 分别为原位和恶性图谱确定了 4 类和 3 类解决方案。女性、白人、年龄在 75 至 84 岁、丧偶、使用公共医疗保险的原位 CRC 患者风险最高，与各自的图谱相比。恶性 CRC 患者风险最高的图谱是男性、黑人、单身/从未结婚和离婚/分居，居住在非阿巴拉契亚县，与各自的图谱相比，使用公共医疗保险。原位和恶性患者的最高风险图谱的 TD 可能性分别为 19.3%和 29.4%。
虽然我们的发现不是用于诊断目的，但我们发现黑人患有原位 CRC 的 TD 较低。相反，在恶性图谱中，黑人的 TD 最高。虽然 TD 不是生存的明确标志，但我们观察到非阿巴拉契亚服务不足/代表性不足的群体在最高 TD 图谱中所占比例过高。观察到的差异可能表明存在可干预的风险。
