Abstract B106: Assessing racial disparities in the receipt of quality care in the most prevalent cancers in American Indians
Authors: Jackson Bradford E. , Emerson Marc E. , Spees Lisa P. , Baggett Chris D. , Morris Hayley N. , Salas Ana I. , Moore Angelo , Raveendran Yadurshini , Meernik Clare , Akinyemiju Tomi , Denlinger-Apte Rachel , Bell Ronny A. , Wheeler Stephanie B. 
Published: December 2023

Abstract
INTRODUCTION Previous SEER-Medicare analyses reported lower receipt of guideline concordant care for American Indian (AI) compared with White (WH) patients across several cancers. While large scale assessments are informative, there is a need to assess cancer outcomes and develop interventions at a level closer to communities. To address this gap, we assessed measures of quality care in AI and WH breast, prostate, and colorectal cancer patients. METHODS We assembled novel cohorts of AI and WH patients from the North Carolina (NC) cancer registry, the state with the largest AI population east of the Mississippi River. Eligible patients were diagnosed with breast, prostate, and colorectal cancers who linked to public and private insurance claims with continuous enrollment (2003-2019). Measures were assessed within 1 year of diagnosis unless stated otherwise. Breast cancer measures included receipt of: (1) HER2 testing within 3 months of diagnosis [NQF #1878]; (2) Tamoxifen/Aromatase Inhibitors for Stage I-III ER/PR+ [NQF #220]; (3) radiation among stage I-III breast conserving surgery or mastectomy patients [NQF #0219]. Stage II-III colorectal cancer measures included receipt of: (1) carcinoembryonic antigen (CEA) testing; (2) surveillance colonoscopy; and (3) computed tomography (CT) among resected patients [NCCN 2.2023 COL-8]. We assessed receipt of prostate-specific antigen (PSA) testing in the first 15 months after prostate cancer diagnosis to monitor disease recurrence. Poisson regression adjusting for sex, urbanicity, insurance type, and age at diagnosis was used to estimate risk ratios (RR) and 95% confidence intervals (CI) comparing the receipt of care between AI and WH patients. RESULTS The sample sizes of AI patients differed across measures, ranging from 104 colorectal to 554 prostate cancer patients. Evidence of disparity was mixed for the breast cancer measures. AI breast cancer patients less frequently received HER2 testing within 3 months of diagnosis (AI=61% vs WH=71%), although adjustment attenuated this association (RR=0.90; CI: 0.81-1.01). Among stage I-III breast cancer patients, AIs more frequently received radiation within 1 year of surgery (AI=75% vs WH=71%) compared with WH patients (RR=1.11; CI: 1.01-1.21). Across colorectal cancer measures, AI patients performed as well or better than WH patients. Notably, AI patients more frequently received CEA testing (AI=71% vs WH=59%), a difference that persisted after adjustment (RR=1.17; CI: 1.03-1.32). AI prostate cancer patients received PSAs less often in the 15 months following diagnosis (AI=82% vs WH=88%) than WH patients (RR=0.96; CI: 0.93-1.00). CONCLUSIONS The magnitude and direction of AI/WH disparities in receipt of quality cancer care differed across measures. Racial misclassification is a challenge in AI health outcomes research, which may misrepresent the experience of AIs. Nevertheless, our findings provide insight into specific areas of breast, prostate, and colorectal cancer care where local tailored interventions can be focused to improve care equity.
Citation Format: Bradford E. Jackson, Marc E. Emerson, Lisa P. Spees, Chris D. Baggett, Hayley N. Morris, Ana I. Salas, Angelo Moore, Yadurshini Raveendran, Clare Meernik, Tomi Akinyemiju, Rachel Denlinger-Apte, Ronny A. Bell, Stephanie B. Wheeler. Assessing racial disparities in the receipt of quality care in the most prevalent cancers in American Indians [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B106.