Racial disparities in colorectal cancer time-to-treatment and survival time in relation to diagnosing hospital cancer-related diagnostic and treatment capabilities

Background: There is a need to understand structural issues, such as differential access to or utilization of technologies or capabilities, to better understand racial disparities in cancer outcomes. The objective of this work was to evaluate time-to-treatment and survival in relation to cancer-related diagnostic and treatment technologies of the diagnosing hospital. Methods: Colorectal tumor-level data from George Cancer Registry was merged with hospital-level cancer technology data from the American Hospital Association (2010-2015). Cox proportional hazard models were used to model time-to-treatment and time-to-death following cancer diagnosis with cancer-related technologies for colon and rectosigmoid/rectal tumors, stratified by race and controlling for personal and tumor characteristics. Results: Black individuals experienced lower likelihood of treatment (HR: 0.92, 95 % CI: 0.89, 0.96) for colon tumors, but not significantly different survival (HR: 1.03, 95 % CI: 0.98, 1.09). Larger capacity or size indicators (total surgical operations, emergency room visits, and licensed beds) were associated with higher likelihood of treatment in whites, but not blacks. Higher counts of treatment related technologies were associated with better survival in whites (HR = 0.92, 95 % CI: 0.85, 0.99), but not blacks (HR: 1.07, 95 % CI: 0.95, 1.19). Virtual colonoscopy emerged as a technology related to survival favorably in whites (HR: 0.84, 95 % CI: 0.77, 0.92) and blacks (HR: 0.89, 95 % CI: 0.79, 1.00). Overall results were similar for rectosigmoid/rectal tumors as observed for colon tumors. Conclusion: The role of cancer-related technologies presence or utilization for colorectal cancer outcomes and potential racial disparities warrants further research.