Changes in Racial Disparities in Mortality After Cancer Surgery in the US, 2007-2016

Key Points

Question

What are the disparities in mortality after cancer surgery between Black and White patients from 2007 to 2016?

Findings

In this cross-sectional study of 870 929 cancer operations over 10 years, overall mortality rates after cancer surgery decreased for both Black and White patients; however, no significant narrowing of the mortality gap between Black and White patients was observed. Mortality improvements were largely associated with within-hospital factors.

Meaning

Overall, mortality rates following cancer surgery appear to be improving for both Black and White patients, but the gap in cancer surgery mortality rates between Black and White patients remains and does not appear to be narrowing.

Abstract

Importance

Racial disparities are well documented in cancer care. Overall, in the US, Black patients historically have higher rates of mortality after surgery than White patients. However, it is unknown whether racial disparities in mortality after cancer surgery have changed over time.

Objective

To examine whether and how disparities in mortality after cancer surgery have changed over 10 years for Black and White patients overall and for 9 specific cancers.

Design, Setting, and Participants

In this cross-sectional study, national Medicare data were used to examine the 10-year (January 1, 2007, to November 30, 2016) changes in postoperative mortality rates in Black and White patients. Data analysis was performed from August 6 to December 31, 2019. Participants included fee-for-service beneficiaries enrolled in Medicare Part A who had a major surgical resection for 9 common types of cancer surgery: colorectal, bladder, esophageal, kidney, liver, ovarian, pancreatic, lung, or prostate cancer.

Exposures

Cancer surgery among Black and White patients.

Main Outcomes and Measures

Risk-adjusted 30-day, all-cause, postoperative mortality overall and for 9 specific types of cancer surgery.

Results

A total of 870 929 cancer operations were performed during the 10-year study period. In the baseline year, a total of 103 446 patients had cancer operations (96 210 White patients and 7236 Black patients). Black patients were slightly younger (mean [SD] age, 73.0 [6.4] vs 74.5 [6.8] years), and there were fewer Black vs White men (3986 [55.1%] vs 55 527 [57.7%]). Overall national mortality rates following cancer surgery were lower for both Black (−0.12%; 95% CI, −0.17% to −0.06% per year) and White (−0.14%; 95% CI, −0.16% to −0.13% per year) patients. These reductions were predominantly attributable to within-hospital mortality improvements (Black patients: 0.10% annually; 95% CI, −0.15% to −0.05%; P < .001; White patients: 0.13%; 95% CI, −0.14% to −0.11%; P < .001) vs between-hospital mortality improvements. Across the 9 different cancer surgery procedures, there was no significant difference in mortality changes between Black and White patients during the period under study (eg, prostate cancer: 0.35; 95% CI, 0.02-0.68; lung cancer: 0.61; 95% CI, −0.21 to 1.44).

Conclusions and Relevance

These findings offer mixed news for policy makers regarding possible reductions in racial disparities following cancer surgery. Although postoperative cancer surgery mortality rates improved for both Black and White patients, there did not appear to be any narrowing of the mortality gap between Black and White patients overall or across individual cancer surgery procedures.

Abstract

This cross-sectional study examines changes in mortality rates over time in White and Black patients undergoing surgery for cancer.