The Effect of Health Insurance on Racial Disparities in Patients With Isolated Colorectal Liver Metastases.

Abstract

Background and objectives: Although resection of colorectal liver metastases (CRLM) improves survival, factors including race and health insurance are associated with disparities in care. The aim of this study was to evaluate the effect of health insurance on racial disparities in CRLM resection.

Methods: A retrospective study of patients with CRC with synchronous CRLM was performed using the National Cancer Database (2004-2020). The primary outcome was resection liver resection. Multivariable logistic regression (MVR) was performed to evaluate the association of race and insurance with the odds of resection.

Results: Forty-four thousand and six hundred sixteen patients were included. Resection rates were lower among Blacks compared to White patients (12.9% vs. 17.3%). By MVR, Black patients (OR 0.76 vs. White), uninsured and Medicaid-insured patients (OR 0.49 and OR 0.71 vs. private insurance) were less likely to undergo resection. On MVR of race stratified by insurance, Black patients with private and Medicare insurance had decreased odds of resection compared to White (OR 0.71 and OR 0.64).

Conclusions: Although Black patients with CRLM have lower odds of hepatic resection compared to White, when stratified by insurance, this was only present among private- and Medicare-insured. Further investigation is warranted to understand other factors associated with racial disparities in this population.