Disparities/Minority Health

Medicare-insured patients with head or neck cancer differ little in mortality risk because of race or ethnicity

Racial and ethnic disparities in mortality essentially disappear for patients with head and neck cancer who are insured by standard (fee-for-service) Medicare, according to a new study. After adjusting for demographic factors; tumor stage, grade, and sites; year of diagnosis; geographic area; number of coexisting conditions; and socioeconomic status, the risk of disease-specific death did not differ significantly among black, Hispanic, and white Medicare beneficiaries. However, blacks had 19 percent higher and Asians had 33 percent lower all-cause mortality than whites.

A major barrier to equal outcomes appeared to be lower socioeconomic status. Individuals in the lowest quartile of socioeconomic status had a 23 percent higher risk of death from all causes and a 17 percent higher disease-specific risk of death than those in the highest quartile.

The researchers used the National Cancer Institute's SEER (Surveillance, Epidemiology, and End Results) database, which includes population-based tumor registries in 17 geographic areas that cover 25 percent of the U.S. population. These data were linked to a Medicare beneficiary database. The researchers analyzed data on 7,480 patients, including 6,208 whites, 522 blacks, 376 Hispanics, 252 Asian-Americans, and 222 others. Treatment information came from SEER registries or Medicare claims. Based on their study, the researchers conclude that equal access to quality health care leads to similar outcomes among different racial or ethnic groups. The study was funded in part by the Agency for Healthcare Research and Quality (HS16743).

More details are in "Racial/ethnic disparities in socioeconomic status, diagnosis, treatment and survival among Medicare-insured men and women with head and neck cancer," by Xianglin L. Du, M.D., Ph.D., and Chih-Chin Liu, M.S., in the Journal of Health Care for the Poor and Underserved 21, pp. 913-930, 2010.

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