African American patients with esophageal cancer survive fewer months after diagnosis than white patients, but only if they also have low incomes, according to a study presented by Loretta Erhunmwunsee, MD, at the Annual Meeting of the Society of Thoracic Surgeons. Dr. Erhunmwunsee led the study while at Duke Health. She is now Assistant Professor in the Division of Thoracic Surgery at City of Hope. Matthew G. Hartwig, MD, Assistant Professor of Surgery at Duke, was the senior author.
Dr. Erhunmwunsee and colleagues used the National Cancer Data Base to gather information on 16,807 patients, of whom 6,147 were treated with esophagectomy for esophageal cancer (stages I-III) between 2003 and 2011. Patients were grouped using median income by zip code. Black patients made up 5% (293) of those who underwent esophagectomy, and 40.3% (2,476) of patients were in the lowest two income quartiles.
Before adjusting for outside factors (age, sex, other health factors, etc), black patients had worse overall survival than did white patients (median survival was 33 vs 46 months, respectively), and each lower income grouping was associated with progressively worse survival.
“These results show that poorer patients are at a higher risk of death following surgery,” said Dr. Erhunmwunsee. “This disparity likely is based on many factors—minority patients and patients with lower socioeconomic status often smoke more, have poor eating habits, exercise less, and are exposed to environmental hazards, all of which lead to worse health. And specifically, increased smoking and poorer eating habits can increase the risk of esophageal cancer.”
Income and Survival
After adjusting for outside factors, both black race and lower income group remained significantly associated with worse overall survival; however, there was no difference in survival rates among black and white patients in the highest two income groups. A significant difference still remained between black and white patients in the lowest income groups (median survival was 26 vs 40 months, respectively), indicating a racial and economic disparity.
Dr. Erhunmwunsee said, “One of the findings of the research is that black patients were much less likely than white patients to undergo surgery,” noting that “surgery is part of the combination treatment that is considered optimal.” African American patients have been known to have higher death rates after esophagectomy. “But our study adds to this finding,” said Dr. Erhunmwunsee, adding “[our study shows] that black patients are most vulnerable when they are poor and that they may actually be protected when they have higher socioeconomic status.” Dr. Hartwig added, “Our study suggests that disparities in survival after being diagnosed with esophageal cancer is less likely due to underlying genetic or medical reasons, and more likely due to disparities in health care…. Based on our findings, we are now able to focus resources on studying lower socioeconomic status among black patients as a way to alleviate health disparities.” ■
Disclosure: Drs. Erhunmwunsee and Hartwig reported no potential conflicts of interest.
1. Erhunmwunsee L: Race is associated with reduced overall survival following esophagectomy for esophageal cancer only among patients from lower socioeconomic backgrounds. 2016 Annual Meeting of the Society of Thoracic Surgeons. General Thoracic Session. Presented January 26, 2016.