Study Protocol: Assessment of Racial/Ethnic Disparities in the Timeliness and Comprehensiveness of Surgery for Colorectal Cancer v1

2021 ◽  
Author(s):  
rhow not provided ◽  
Vidhya Gunaseelan ◽  
mbicket not provided
Keyword(s):  
Ethnic Group ◽  
Regression Models ◽  
Primary Outcome ◽  
Elective Surgery ◽  
Preoperative Staging ◽  
Ethnic Disparities ◽  
Study Groups ◽  
Logistic Regression Models ◽  
Racial Ethnic ◽  
Emergent Surgery

This retrospective cohort study will investigate the timeliness of surgery based on the racial/ethnic group of patients who under colorectal surgery for cancer. Patients are included if they underwent surgical procedures for colon cancer between January 1, 2015 and April 30, 2020. The primary exposure of interest is the racial/ethnic group of the patient. The primary outcome is the the timeliness of surgery, defined as having urgent/emergent surgery (less timely) vs. elective surgery (more timely). Secondary outcomes relate to comprehensiveness of surgery, and include performance of preoperative staging tests, preoperative lab testing, and preoperative teaching of patients, as well as length of stay and additional clinical outcomes. Multivariable logistic regression models will be used to adjust for other demographic and clinical differences between study groups.

scholarly journals POS0023 RACIAL/ETHNIC AND REGIONAL DIFFERENCES IN MULTIMORBIDITY BETWEEN PATIENTS WITH RHEUMATOID ARTHRITIS AND COMPARATORS IN A LARGE NATIONWIDE US STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 213.1-214
Author(s):  
H. J. Dykhoff ◽  
E. Myasoedova ◽  
M. Peterson ◽  
J. M. Davis ◽  
V. Kronzer ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Logistic Regression ◽  
Regression Models ◽  
Index Date ◽  
Ethnic Disparities ◽  
Logistic Regression Models ◽  
The Us ◽  
Race Ethnicity ◽  
Geographic Regions ◽  
Racial Ethnic

Background:Patients with rheumatoid arthritis (RA) have an increased burden of multimorbidity. Racial/ethnic disparities have also been associated with an increased burden of multimorbidity.Objectives:We aimed to compare multimorbidity among different racial/ethnic groups and geographic regions of the US in patients with RA and comparators without RA.Methods:We used a large longitudinal, real-world data warehouse with de-identified administrative claims for commercial and Medicare Advantage enrollees, to identify cases of RA and matched controls. Cases were defined as patients aged ≥18 years with ≥2 diagnoses of RA in January 1, 2010 - June 30, 2019 and ≥1 prescription fill for methotrexate in the year after the first RA diagnosis. Controls were persons without RA matched 1:1 to RA cases on age, sex, census region, calendar year of index date (corresponding to the date of second diagnosis code for RA), and length of prior medical/pharmacy coverage. Race was classified as non-Hispanic White (White), non-Hispanic Black (Black), Asian, Hispanic, or other/unknown, based on self-report or derived rule sets. Multimorbidity (2 or more comorbidities) was defined using 25 chronic comorbidities from a combination of the Charlson and Elixhauser Comorbidity Indices assessed during the year prior to index date. Rheumatic comorbidities were not included. Logistic regression models were used to estimate odds ratios (OR) with 95% confidence intervals (CI).Results:The study included 16,363 cases with RA and 16,363 matched non-RA comparators (mean age 58.2 years, 70.7% female for both cohorts). Geographic regions were the same in both cohorts: 50% South, 26% Midwest, 13% West, and 11% Northeast. Race/ethnicity was not part of the matching criteria and varied slightly between the cohorts: among RA (non-RA) patients, 74% (74%) were White, 11% (9%) Hispanic, 10% (9%) Black, 3% (4%) Asian, and 3% (4%) other/unknown. Patients with RA had more multimorbidity than non-RA subjects (51.3% vs 44.8%). Multimorbidity comparisons across US geographic regions were similar in both cohorts, with comparable multimorbidity levels for patients in the West and Midwest and higher levels for those in the Northeast and South (Figure 1). Among the non-RA patients, 43.5% of Whites experienced multimorbidity, compared to 33.9% of Asians, 46.1% of Hispanics, and 58.4% of Blacks. These associations remained after adjustment for age, sex, and geographic region, with significantly lower multimorbidity among Asians (OR: 0.81; 95%CI: 0.67-0.99) and significantly higher multimorbidity among Hispanics (OR: 1.21; 95%CI: 1.07-1.37) and Blacks (OR: 1.74; 95%CI: 1.54-1.97), compared to Whites in the non-RA cohort. Among the RA patients, racial/ethnic differences were less pronounced; 50.6% of Whites, 42.8% of Asians, 48.8% of Hispanics, and 58.4% of Blacks experienced multimorbidity. Adjusted analyses revealed no significant differences in multimorbidity for Asians (OR: 0.88; 95%CI: 0.70-1.08) and Hispanics (OR: 1.06; 95%CI: 0.95-1.19) and a less pronounced increase in multimorbidity among Blacks (OR: 1.32; 95%CI: 1.17-1.49) compared to Whites in the RA cohort.Conclusion:This large nationwide study showed increased occurrence of multimorbidity in RA versus non-RA patients and in both cohorts for residents of the Northeast and South regions of the US. Racial/ethnic disparities in multimorbidity were more pronounced among patients without RA compared to RA patients. This indicates the effects of RA and race/ethnicity on multimorbidity do not aggregate. The underlying mechanisms for these associations require further investigation.Figure 1.Logistic regression models comparing multimorbidity levels in RA and non-RA cohorts.Disclosure of Interests:Hayley J. Dykhoff: None declared, Elena Myasoedova: None declared, Madeline Peterson: None declared, John M Davis III Grant/research support from: Research grant from Pfizer, Vanessa Kronzer: None declared, Caitrin Coffey: None declared, Tina Gunderson: None declared, Cynthia S. Crowson: None declared.

Abstract TMP48: Effect of Pre-Morbid Antianxiety and Antidepressant Medications on Ischemic Stroke Functional Outcome

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Cecilia Peterson ◽  
Ka-Ho Wong ◽  
Michael Dela Cruz ◽  
Kirby Taylor ◽  
Jennifer J Majersik ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Regression Models ◽  
Primary Outcome ◽  
Negative Impact ◽  
Secondary Analysis ◽  
Anxiety And Depression ◽  
Neuroprotective Effects ◽  
Logistic Regression Models ◽  
Antidepressant Medications

Introduction: Antianxiety and antidepressant medications have shown some neuroprotective effects following stroke. However, the effect of premorbid use of these medications remains unclear. Hypothesis: Pre-morbid exposure to antianxiety or antidepressant medications will negatively impact recovery from acute ischemic stroke, measured by modified Rankin scale (mRS) at 90 days after stroke onset. Methods: This is a secondary analysis of the Albumin in Acute Ischemic Stroke (ALIAS) 2 trial. The primary outcome is 90-day mRS 0-1. The exposure is premorbid antidepressant or antianxiety medication. We fit univariate and multivariate logistic regression models to our outcome, with covariates chosen using a stepwise backwards interactive selection. Results: We included 806 patients with a mean (SD) age of 64.4 (12.8) years. The median (IQR) NIH Stroke Scale was 11 (8, 17) and 54.3% were male, 75.6% were Caucasian, 88.8% received tPA, 72.5% had hypertension, and 20.3% had diabetes. A total of 140/806 (17.4%) of patients took either an antidepressant or antianxiety medication, of which 91 took an antidepressant, 34 took an antianxiety medication, and 15 took both. The median (IQR) mRS Scale was one point higher in patients on antidepressant or antianxiety medication pre-stroke (3 vs. 2, p=0.019). The primary outcome of mRS 0-1 was seen in 37.7% of all patients. Taking an antidepressant or antianxiety medication was associated with lower odds of a good outcome in univariate (OR 0.61, 95% CI 0.41-0.91, p=0.015) and multivariate models (aOR 0.62, 95% CI 0.40-0.95, p=0.027) (Table 1). Conclusion: Pre-morbid exposure to antianxiety or antidepressant medications is associated with a worse outcome after acute ischemic stroke. This may be due to a negative impact of pre-stroke anxiety and depression that outweigh any neuroprotective factors of these medications.

An Examination of Racial/Ethnic Disparities in Truancy Court

2019 ◽  
Vol 66 (1) ◽  
pp. 33-58
Author(s):  
Laura L. Rubino ◽  
Valerie R. Anderson ◽  
Christina A. Campbell
Keyword(s):  
Regression Models ◽  
Ethnic Disparities ◽  
Initial Contact ◽  
White Youth ◽  
School To Prison Pipeline ◽  
Status Offense ◽  
Race Ethnicity ◽  
Racial Ethnic

The purpose of this study was to examine the effect of race/ethnicity on recidivism outcomes with a sample of juveniles involved with a truancy court. Three regression models were conducted to examine the influence of race/ethnicity on receiving any new court petition ( N = 1,206), including petitions for delinquency offenses or any new status offense petition within 2 years of their initial contact with the court. Results suggest that racial/ethnic disparities exist for juveniles involved in truancy court, especially with regard to new delinquency petitions. These findings are important to take into consideration to understand how truancy courts may facilitate the school-to-prison pipeline for non-White youth.

scholarly journals Sex and Race/Ethnic Disparities in Food Security and Chronic Diseases in U.S. Older Adults

2017 ◽  
Vol 3 ◽  
pp. 233372141771834 ◽  
Author(s):  
Joan A. Vaccaro ◽  
Fatma G. Huffman
Keyword(s):  
Older Adults ◽  
Food Security ◽  
Lung Disease ◽  
Chronic Diseases ◽  
Regression Models ◽  
Ethnic Disparities ◽  
Minority Status ◽  
Logistic Regression Models ◽  
Health And Nutrition ◽  
Race Ethnicity

Objective: The purpose of this study was to determine the relationships among sex, race/ethnicity, and food security with the likelihood of cancer, diabetes, cardiovascular disease, and lung disease for older adults. Method: Complex sample analysis by logistic regression models for chronic diseases were conducted from National Health and Nutrition Examination Surveys, 2011 to 2012 and 2013 to 2014, for N = 3,871 adults aged ≥55 years. Results: Being female with low food security was associated with lung disease and diabetes. Poverty, rather than low food security, was associated with cardiovascular diseases. Minority status was independently associated with low food security and diabetes. Discussion: Food insecurity, sex, and race/ethnicity were associated with chronic diseases in a representative sample of U.S. older adults.

scholarly journals Risk Factors for Death Among Hospitalized Patients Aged 21–64 Years Diagnosed with COVID-19—New York City, March 13–April 9, 2020

2021 ◽  
Author(s):  
Dena Bushman ◽  
Alexander Davidson ◽  
Preeti Pathela ◽  
Sharon K. Greene ◽  
Don Weiss ◽  
...  
Keyword(s):  
Risk Factors ◽  
New York ◽  
Social Services ◽  
Minority Groups ◽  
Conditional Logistic Regression ◽  
Ethnic Disparities ◽  
Logistic Regression Models ◽  
Residential Neighborhood ◽  
And Control ◽  
Racial Ethnic

Abstract Background COVID-19 mortality studies have primarily focused on persons aged ≥ 65 years; less is known about decedents aged <65 years. Methods We conducted a case-control study among NYC residents aged 21–64 years hospitalized with COVID-19 diagnosed March 13–April 9, 2020, to determine risk factors for death. Case-patients (n=343) were hospitalized decedents with COVID-19 and control-patients (n=686) were discharged from hospitalization with COVID-19 and matched 2:1 to case-patients on age and residential neighborhood. Conditional logistic regression models were adjusted for patient sex, insurance status, and marital status. Matched adjusted odds ratios (aORs) were calculated for selected underlying conditions, combinations of conditions, and race/ethnic group. Results Median age of both case-patients and control-patients was 56 years (range: 23–64 years). Having ≥ 1 selected underlying condition increased odds of death 4.45-fold (95% CI: 2.33–8.49). Patients with diabetes; morbid obesity; heart, kidney, or lung disease; cancer; neurologic/neurodevelopmental conditions; mental health conditions; or HIV had significantly increased odds of death. Compared with having neither condition, having both diabetes and obesity or diabetes and heart disease was associated with approximately threefold odds of death. Five select underlying conditions were more prevalent among non-Hispanic Black control-patients than among control-patients of other races/ethnicities. Conclusions and Relevance Selected underlying conditions were risk factors for death, and most prevalent among racial/ethnic minorities. Social services; health care resources, including vaccination; and tailored public health messaging are important for COVID-19 prevention. Strengthening these strategies for racial/ethnic minority groups could minimize COVID-19 racial/ethnic disparities.

scholarly journals Racial and Ethnic Disparities in Cesarean Delivery and Indications Among Nulliparous, Term, Singleton, Vertex Women

2021 ◽  
Author(s):  
Ijeoma C. Okwandu ◽  
Meredith Anderson ◽  
Debbie Postlethwaite ◽  
Aida Shirazi ◽  
Sandra Torrente
Keyword(s):  
Logistic Regression ◽  
Black Women ◽  
Cesarean Delivery ◽  
Regression Models ◽  
White Women ◽  
Ethnic Disparities ◽  
Logistic Regression Models ◽  
Nulliparous Women ◽  
Race Ethnicity ◽  
Failure To Progress

Abstract Objective To compare cesarean delivery rates and indications by race/ethnicity among nulliparous women with term, singleton, vertex presentation deliveries. Methods This is a retrospective cohort study of nulliparous women delivering term, singleton, vertex neonates at Kaiser Permanente Northern California from 1/1/2016 to 6/30/2017. Women with cesarean for elective, malpresentation, or previa were excluded. Multivariable logistic regression models adjusting for maternal, neonatal, and facility factors were used to assess the likelihood of cesarean by race/ethnicity. Further modeling was performed to examine odds of cesarean for the indications of failure to progress and fetal intolerance by race/ethnicity. Results The cohort of 16,587 racially/ethnically diverse women meeting inclusion and exclusion criteria consisted of 41.62% White, 27.73% Asian, 22.11% Hispanic, 5.32% Black, and 3.21% multiple race/other women. In adjusted logistic regression models, all race and ethnic categories had higher odds of cesarean deliveries in comparison to White women. Black women had the highest odds of cesarean delivery (adjusted OR [aOR] = 1.73, 95% CI: 1.45–2.06), followed by Asian (aOR = 1.59, 95% CI: 1.45–2.06), multiple race/other (aOR = 1.45, 95% CI: 1.17–1.80), and Hispanic (aOR = 1.43, 95% CI: 1.28–1.59) women. Compared with White women, Asian (aOR = 1.46, 95% CI: 1.22–1.74) and Hispanic (aOR = 1.25, 95% CI: 1.03–1.52) women had higher odds of failure to progress as the indication. Among women with failure to progress, Black (aOR = 0.50, 95% CI: 0.30–0.81), Hispanic (aOR = 0.68, 95% CI: 0.53–0.87), and Asian (aOR = 0.77, 95% CI: 0.61–0.96) women were less likely than White women to reach 10 cm dilation. Compared with White women, Black women were more likely to have cesarean delivery for fetal intolerance (aOR = 1.51, 95% CI: 1.10–2.07). Among women with fetal intolerance of labor, there were no significant differences by race/ethnicity for Apgar score or neonatal intensive care unit admission. Conclusions Race/ethnicity was significantly associated with the odds of cesarean and indication. All other race/ethnicity groups had higher odds of cesarean compared with White women. Compared with White women, Black women had greater odds of fetal intolerance as an indication, while Hispanic and Asian women had greater odds of failure to progress. Maternal, neonate, and facility factors for cesarean delivery did not explain the observed disparities in cesarean delivery rates.

Abstract WP39: Intraprocedural Systolic Blood Pressure Mean and Variability During Endovascular Thrombectomy Not Associated With Neurologic Outcome

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Mohammad Anadani ◽  
Adam De Havenon ◽  
Linda M Baki ◽  
Alejandro M Spiotta
Keyword(s):  
Blood Pressure ◽  
Logistic Regression ◽  
Systolic Blood Pressure ◽  
Regression Models ◽  
Primary Outcome ◽  
Neurologic Outcome ◽  
Anterior Circulation ◽  
Endovascular Thrombectomy ◽  
Logistic Regression Models ◽  
Adjusted Logistic Regression

Background: Prior research has shown that increased systolic blood pressure variability (BPV) is associated with worse neurologic outcome after endovascular thrombectomy (EVT). Those studies have typically included BPV from 24-72 hours after stroke onset, but none have focused specifically on the BPV during EVT. Methods: We included acute ischemic stroke patients who underwent EVT for anterior circulation large vessel occlusion from 2 stroke centers. All patients had a minimum of 10 blood pressure readings during EVT. The primary outcome is mRS 0-2 (good outcome) and the secondary outcome is death, both as close to 90 days as possible. We fit adjusted logistic regression models to our outcomes with the predictors of intraprocedural systolic mean, standard (SD), and coefficient of variation (CV). Results: We included 303 patients with a mean (SD) age of 65.7 years and 53.5% were female. The primary outcome of mRS 0-2 was met by 39.9% and 27.4% died. Systolic mean, SD, and CV did not differ in patients with mRS 0-2 versus 3-6 (Table 1) nor for patients who died versus were alive (all p>0.5). In the adjusted logistic regression models, systolic mean, SD, and CV were not associated with either mRS 0-2 or death at follow-up (Tables 2 & 3). Conclusions: Blood pressure variation during endovascular thrombectomy was not associated with the functional outcome or death in patients with anterior circulation strokes.

Abstract P502: Significance of Asymptomatic Hemorrhage After Mechanical Thrombectomy: A Post-Hoc Analysis of the Best Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Michael Feldman ◽  
Steven Roth ◽  
Matthew Fusco ◽  
Shadi Yaghi ◽  
Tapan V Mehta ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Regression Models ◽  
Primary Outcome ◽  
Mechanical Thrombectomy ◽  
Logistic Regression Models ◽  
Post Hoc Analysis ◽  
Conflicting Evidence ◽  
The Us ◽  
Post Hoc

Introduction: Intracerebral hemorrhage (ICH) occurs in 20-30% of the stroke patients undergoing endovascular therapy (EVT). However, there is conflicting evidence regarding the effect of asymptomatic ICH (aICH) on post-EVT outcomes. Methods: In this post-hoc analysis of our multi-center, prospective, “Blood Pressure after Endovascular Therapy (BEST)” study, we determined the rates of patients with aICH and symptomatic ICH (sICH; any ICH associated with ≥4 points deterioration in the baseline NIH Stroke scale). Their associations with a primary outcome of 90-day modified Rankin Scores (mRS) 0-2 vs 3-6 and early neurological recovery (ENR; NIHSS of 0-1 or ≥8-point improvement at 24 hours from baseline) was determined using univariable and multivariable logistic regression models (adjusted for age, NIH stroke scale, ASPECT score, age, thrombolytic administration, and successful recanalization defined as mTICI ≥2b). Results: Of 485 patients included in BEST at 12 comprehensive stroke centers across the US, 446 patients had a 90-day follow-up available. Of these, 92 (20.6%) developed aICH and 18 (4%) developed sICH. The aICH was not associated with worse 90-day outcome or lower ENR (OR 1.19 [0.74-1.88], p=0.45, aOR 1.19 [0.69-2.06], p= 0.53 for 90-day mRS 3-6; OR 0.77 [0.48-1.23], p=0.30, aOR 0.72 [0.43-1.22] for ENR).A higher proportion of patients with aICH had mTICI ≥2b compared to those without any ICH (97%vs 87%, p=0.01, Table). The aICH was not associated with 90-day outcome or ENR in patients with mTICI ≥2b (OR 1.28 [0.79-2.08], p=0.32 for 90-day mRS 3-6; OR 0.89 [0.69-1.12], p=0.14 for ENR). Conclusion: We found insufficient evidence that aICH associated with worse outcomes in EVT-treated patients, including those with successful recanalization. Interestingly, aICH was more frequent in patients with successful recanalization. Further validation of our findings in other large cohort studies of EVT-treated patients is warranted.

scholarly journals Development and Validation of a Risk Prediction Model for Acute Kidney Injury After the First Course of Cisplatin

2018 ◽  
Vol 36 (7) ◽  
pp. 682-688 ◽  
Author(s):  
Shveta S. Motwani ◽  
Gearoid M. McMahon ◽  
Benjamin D. Humphreys ◽  
Ann H. Partridge ◽  
Sushrut S. Waikar ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Serum Albumin ◽  
Regression Models ◽  
Primary Outcome ◽  
Estimated Glomerular Filtration Rate ◽  
Demographic Data ◽  
Kidney Injury ◽  
Logistic Regression Models ◽  
History Of ◽  
Development And Validation

Purpose Cisplatin-associated acute kidney injury (C-AKI) is common. We sought to develop and validate a predictive model for C-AKI after the first course of cisplatin. Methods Clinical and demographic data were collected on patients who received cisplatin between 2000 and 2016 at two cancer centers. C-AKI was defined as a 0.3 mg/dL rise in serum creatinine within 14 days of receiving cisplatin. Using multivariable logistic regression models with C-AKI as the primary outcome, we created a scoring model from the development cohort (DC) and tested it in the validation cohort (VC). Results C-AKI occurred in 13.6% of 2,118 patients in the DC and in 11.6% of 2,363 patients in the VC. Factors significantly associated with C-AKI included age 61 to 70 years (odds ratio [OR], 1.64 [95% CI, 1.21 to 2.23]; P = .001) and 71 to 90 years (OR, 2.97 [95% CI, 2.06 to 4.28]; P < .001) compared with ≤ 60 years; cisplatin dose 101 to 150 mg (OR, 1.58 [95% CI, 1.14 to 2.19]; P = .007) and > 150 mg (OR, 3.73 [95% CI, 2.68 to 5.20]; P < .001) compared with ≤ 100 mg; a history of hypertension (OR, 2.10 [95% CI, 1.54 to 2.72]; P < .001) compared with no hypertension; and serum albumin 2.0 to 3.5 g/dL (OR, 2.21 [95% CI, 1.62 to 3.03]; P < .001) compared with > 3.5 g/dL. The baseline estimated glomerular filtration rate was not significantly associated with the risk of C-AKI. The c-statistics of the score-based model in the DC and the VC were 0.72 (95% CI, 0.69 to 0.75) and 0.70 (95% CI, 0.67 to 0.73), respectively. Scores of 0, 3.5, and 8.5 were associated with a probability of C-AKI of 0.03 (95% CI, 0.03 to 0.05), 0.12 (95% CI, 0.11 to 0.14), and 0.51 (95% CI, 0.43 to 0.60), respectively. Conclusion A score-based model created by using the patient’s age, cisplatin dose, hypertension, and serum albumin is predictive of C-AKI.

scholarly journals Factors Associated With Patient's Refusal of Recommended Cancer Surgery: Based on Surveillance, Epidemiology, and End Results

2022 ◽  
Vol 9 ◽  
Author(s):  
Xianglin Hu ◽  
Hui Ye ◽  
Wangjun Yan ◽  
Yangbai Sun
Keyword(s):  
Marital Status ◽  
Cancer Patients ◽  
Metastatic Cancer ◽  
Ethnic Disparities ◽  
Cancer Surgery ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Insurance Type ◽  
Racial Ethnic ◽  
End Results

ObjectivesMost non-metastatic cancer patients can harvest a preferable survival after surgical treatment, however, patients sometimes refuse the recommended cancer-directed surgery. It is necessary to uncover the factors associated with patent's decision in taking cancer surgery and explore racial/ethnic disparities in surgery refusal.MethodsBased on the Surveillance, Epidemiology and End Results (SEER)-18 program, we extracted data of non-metastatic cancer patients who didn't undergo surgery. Ten common solid cancers were selected. Four racial/ethnic categories were included: White, black, Hispanic, and Asian/Pacific Islander (API). Primary outcome was patient's refusal of surgery. Multivariable logistic regression models were used, with reported odds ratio (OR) and 95% confidence interval (CI).ResultsAmong 318,318 patients, the incidence of surgery refusal was 3.5%. Advanced age, female patients, earlier cancer stage, uninsured/Medicaid and unmarried patients were significantly associated with higher odds of surgery refusal. Black and API patients were more likely to refuse recommended surgery than white patients in overall cancer (black-white: adjusted OR, 1.18; 95% CI, 1.11–1.26; API-white: adjusted OR, 1.56; 95% CI, 1.41–1.72); those racial/ethnic disparities narrowed down after additionally adjusting for insurance type and marital status. In subgroup analysis, API-white disparities in surgery refusal widely existed in prostate, lung/bronchus, liver, and stomach cancers.ConclusionsPatient's socioeconomic conditions reflected by insurance type and marital status may play a key role in racial/ethnic disparities in surgery refusal. Oncological surgeons should fully consider the barriers behind patient's refusal of recommended surgery, thus promoting patient-doctor shared decision-making and guiding patients to the most appropriate therapy.

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