DISPARITIES AND HEALTH EQUITY
Authors: Samuel C.A. , Elkins W. , Tan X. , Corbie‐Smith G. , Cykert S. , Mbah O. , Padilla N. , Bensen J.T. , Farnan L. , Bennett A.V. , Rosenstein D. , Sanoff H. , Reeve B.B. 
Published: August 2020

Research Objective

Racial disparities in health care experiences and access are well‐documented. Yet, little is known regarding racial variations in the confluence of multiple health care access (HCA) experiences among cancer patients. We identified cancer patient subgroups with similar, co‐occurring HCA experiences, and evaluated racial differences in HCA subgroup membership.

Study Design

We used data from the University of North Carolina Health Registry/Cancer Survivorship Cohort. Participants completed a baseline questionnaire assessing demographics, health history, health‐related quality of life, and health care experiences. HCA was assessed along five domains (ie, doctor interpersonal manner, doctor communication, financial burden, time spent with doctor, and accessibility/convenience) using the RAND Patient Satisfaction Questionnaire. We used latent profile analysis to identify subgroups of patients with similar HCA experiences. Modified Poisson regressions were estimated to assess racial differences in HCA subgroup membership, adjusting for patient clinical and demographic characteristics.

Population Studied

Black and white breast, gastrointestinal, genitourinary, and head/neck cancer patients aged 18 or older and enrolled in the University of North Carolina Health Registry/Cancer Survivorship Cohort during 2010 to 2016.

Principal Findings

Our analysis included 393 black (14.8%) and 2265 white (85.2%) participants. The latent profile analysis resulted in an optimal solution of 5 HCA profiles/subgroups, ranging from Low HCA to High HCA. Members of profile 1 (6.0% of sample) reported “Low” HCA along all HCA domains. Profile 2 (10.8%) consisted of individuals reporting low scores on every HCA domain except “financial burden,” where scores were moderate. Profile 3 (49.9%) members exhibited moderate scores on each HCA domain, while members of profile 4 (11.7%%) reported moderate HCA scores on most HCA domains, with the exception of low scores on “financial burden.” Profile 5 (21.7%) was comprised of patients reporting “High” HCA along every HCA domain. In unadjusted chi‐square comparisons, black patients were more likely to be in the “Low” HCA group (Profile 1) than whites (11.11% vs 5.3%, P < .001), but less likely to be in the “High” HCA group (13.2% vs 22.8%, P < .001). In adjusted regressions predicting subgroup membership, black race was associated with a 34% lower likelihood of membership in the “High” HCA subgroup (adjusted risk ratio [ARR] = 0.66; CI: 0.51‐0.87]. Other patient characteristics associated with the “High HCA” subgroup membership included holding a postgraduate degree (ARR = 1.33; CI: 1.06‐1.68) and being married (ARR = 1.22; CI: 1.03‐1.44).

Conclusions

Distinct patterns of co‐occurring HCA experiences exist among cancer patients, with black patients reporting worse care experiences relative to whites across multiple HCA domains.

Implications for Policy or Practice

Our findings point to potential opportunities for identifying patient subgroups especially vulnerable to worse outcomes due to their collective HCA experiences. Routinely collecting HCA data alongside health care outcomes data in diverse cancer patients may be helpful in addressing disparities in HCA and outcomes.

Primary Funding Source

National Institutes of Health.