EP743 - Hidden Disparities in Colorectal Cancer Surgery: A Comparison of Post-operative Healthcare utilization and Mortality between Immigrants and Non-Immigrants.

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Purpose/Background: Immigrants are more likely to present with late-stage colorectal cancer compared to non-immigrants, partially due to language and cultural barriers that delay access to screening. Delayed presentation increases risk of surgical complications and post-operative mortality. Post-operative care is essential for detecting complications and improving outcomes, yet little is known about immigrants' experiences recovering from colorectal surgery. This study provides population-based analysis in British Columbia (B.C.), Canada that compares post-operative colorectal surgery healthcare utilization and mortality between immigrants and non-immigrants.

Methods/Interventions: All colorectal malignancy resections performed in British Columbia, Canada, between 2012 and 2020 were identified using longitudinal administrative data, which linked immigration, census, and hospital records. Post-operative healthcare utilization, defined as length of stay (LoS), emergency department (ED) visits, readmissions, and re-operations within 30 days, were compared between immigrants and non-immigrants, adjusting for age, sex, Charlson comorbidity score, socioeconomic status, and rural hospital status. Post-operative odds of death were also measured as a secondary outcome. Outcomes were compared between immigrants from 'visible minority' countries and those from Caucasian or European countries based on country of birth.

Results/Outcomes: Among 18,011 colorectal malignancy resections, 1,906 (10.6%) were performed on immigrants, consistent with immigration statistics. Compared with non-immigrants, immigrants had a shorter post-operative length of stay (LoS) (6.8 vs. 8.0 days, p< 0.01) but comparable rates of ED visits, readmissions, and re-operations within 30 days. After adjusting for patient- and system-level factors, immigrants experienced significantly shorter LoS (RR 0.89, 95%CI: 0.85-0.93). Immigrants from ‘visible minority’ countries had shorter LoS compared to those from Caucasian or European countries (RR 0.88, 95%CI: 0.84-0.92). Immigrants were more likely to experience death within one year of surgery (OR 1.15, 95%CI: 1.02-1.29).

Conclusion/Discussion: Immigrants’ experiences with the healthcare system is different from non-immigrants. Effective screening and prevention are falling short for immigrants; they face significantly higher odds of one-year mortality compared to non-immigrants despite having comparable rates of healthcare utilization. System level interventions that address gaps in symptom communication and health literacy among immigrants, particularly those from visible minority groups are essential and overdue to reduce disparities in health and well-being outcomes.