Disparities in Guideline-Concordant Treatment and Survival Among Border County Residents with Gastric Cancer Open Access

Ju, Michelle (Summer 2021)

Permanent URL: https://etd.library.emory.edu/concern/etds/kw52j928g?locale=en


Background: Previous studies have shown health disparities among US-Mexico border county (BC) residents. However, the impact of BC residence on gastric cancer treatment and survival outcomes is unknown. Our study compares receipt of guideline-concordant care (GCC) and survival for gastric cancer patients by BC status.

Methods: We conducted a retrospective review of adult Non-Hispanic White and Hispanic patients with gastric adenocarcinoma diagnosed between 2004-2017 in the Texas Cancer Registry. Chi-square tests were used to compare categorical group differences, with pooled t-tests used to compare group means. The impact of BC residence on likelihood of receiving GCC was assessed with logistic regression. Overall survival was estimated using the Kaplan-Meier method and compared with log-rank tests.

Results: Our cohort consisted of 12,514 patients (15% BC). Overall, 45% of non-border county (NBC) residents received GCC vs 35% of BC residents (p<0.0001). After adjusting for age, race, stage, and insurance status, BC patients remained significantly less likely to receive GCC (OR 0.68, 95% CI 0.60-0.78). BC residence was associated with increased hazard of all-cause mortality after accounting for age, race, stage, poverty index, and treatment receipt (HR 1.11, 95% CI 1.04-1.18). BC residents had significantly worse overall survival for localized and regional disease.

Conclusions: BC residents with gastric cancer have worse survival outcomes than NBC residents. This significant survival disparity is likely related to receipt of suboptimal care among BC residents as demonstrated by lower likelihood of GCC. Further studies are needed to identify specific contributing mechanisms to improve healthcare equity.

Table of Contents

Chapter 1: Literature Review

Pages 1-8

Statement of the Problem and Purpose of Thesis

Page 8

Chapter 2: Manuscript

Pages 9-31


Pages 10-11

Manuscript Body

Pages 12-21


Pages 22-31

Chapter 3: Conclusions

Pages 32-37

References Cited

Pages 38-45

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