EP703 - An Intersectional Approach to Civilian versus Inmate Access to Care in Treatment of Colorectal Cancer

Image or Table (Do Not add text here):

Purpose/Background: Timely treatment following colorectal cancer (CRC) diagnosis remains a major barrier for racial minorities and socioeconomically disadvantaged patients in the U.S. These factors compound heavily on incarcerated patients, who represent a particularly vulnerable patient population with high rates of cancer mortality. Through an intersectional lens, we aimed to define disparities between incarcerated and non-incarcerated persons with CRC.

Methods/Interventions: A retrospective review was conducted on 1305 patients with biopsy proven CRC, including 1169 civilians and 136 inmates, treated at a single academic tertiary care center between 2010 and 2023. Information on individuals’ race, sex, disease stage, setting of diagnosis (inpatient vs. outpatient), and time to initial treatment following CRC diagnosis was obtained. Subjects were divided into four (4) groups: White race + civilian status, White race + inmate status, Black race + civilian status, and Black race + inmate status. Other racial groups were excluded due to inadequate representation. One-way ANOVA was next used to measure differences in time to treatment between groups. Univariate chi-squared analysis and multivariate binomial logistic regression were performed to determine associations between patient demographics and clinical or pathologic stage as well as setting of diagnosis.

Results/Outcomes: Average time to treatment for patients of civilian status was 35.01 days, while average time to treatment for patients of inmate status was 56.59 days. In analyzing impacts of incarceration status, inmates received treatment three (3) weeks (21.57 days, p< 0.001) later than civilians. In analyzing impacts of race, White inmates received treatment 32.70 days later than Black inmates (p < 0.016). There was no significant difference in time to treatment between White civilians and Black civilians. Analysis of impacts of both incarceration status and race together revealed that White inmates received initial treatment six (6) weeks (42.14 days, p< 0.001) later than White civilians. However, there was no statistically significant difference in time to treatment between Black inmates and Black civilians (7.619 days, p< 0.898).

Regarding setting of diagnosis, Black patients were more likely to receive CRC diagnosis in the emergency department or inpatient setting compared to White patients (OR 2.12 [1.65, 2.70]). There was no significant difference in setting of diagnosis between civilians and inmates.

Regarding stage at diagnosis, there were no significant differences in pathologic stage or clinical stage for patients with colon cancer or rectal cancer in relation to incarceration status or race.

Conclusion/Discussion: Our results demonstrate that racial inequity endures as an overarching theme in healthcare access and timely treatment of CRC. Non-incarcerated Black patients with newly diagnosed CRC fare no better than incarcerated Black patients when it comes to timeliness of care. It is critical that intentional efforts are made to improve education, enhance access to screening, and refine treatment planning and referral patterns to improve outcomes of racially underrepresented minorities and incarcerated persons with CRC.