D. Dillon1, K. D. Klingbeil2,3, E. Zarrinkhoo4, K. Bechay1, J. Y. Park2, J. M. Rook2, M. A. Mederos2, M. D. Girgis2, K. Chen5, R. Bastani6, S. Manouchehr-Pour7, K. Viragh7, M. Thomas7, V. Chiu8, B. E. Kadera2,3 1David Geffen School Of Medicine, University Of California At Los Angeles, Los Angeles, CA, USA 2David Geffen School Of Medicine, University Of California At Los Angeles, Department Of Surgery, Division Of Surgical Oncology, Los Angeles, CA, USA 3Jonsson Comprehensive Cancer Center, University Of California, Los Angeles, Los Angeles, CA, USA 4UCLA-Olive View, Department Of Internal Medicine, Sylmar, CA, USA 5David Geffen School Of Medicine, University Of California At Los Angeles, Department Of Medicine, Statistics Core, Los Angeles, CA, USA 6Fielding School of Public Health, University Of California, Los Angeles, Los Angeles, CA, USA 7UCLA-Olive View, Department Of Radiology, Sylmar, CA, USA 8UCLA-Olive View, Department Of Medicine, Division Of Medical Oncology, Sylmar, CA, USA
Introduction: Various population-based studies have shown Latino patients with gastric cancer experience worse survival compared to patients of other backgrounds. This finding has previously been linked to disparate access to healthcare. We aimed to address whether Latino patients treated within a multi-center, safety-net hospital system continue to experience decreased survival.
Methods: We performed a retrospective cohort study comparing survival between Latino and non-Latino patients diagnosed with gastric adenocarcinoma between January 1, 2016 to December 31, 2020 within Los Angeles County’s safety-net hospital system. Gastric cancer-specific survival was compared between the two cohorts using the Kaplan-Meier estimate and Cox proportional-hazards regression model.
Results: 448 patients who received care from five medical centers were included in the study. 348 (77.7%) patients self-identified as Latino and 100 (22.3%) as non-Latino. Mean follow-up was 2.0 years (median 0.91 years, IQR, 0.34-2.5 years). Latino patients were diagnosed at a younger age (55.6 vs 60.7 years, p < 0.01), demonstrate higher area deprivation index (6.4 vs 5.0 state decile, p < 0.01), were more likely to receive a misdiagnosis (25% vs 14%, p < 0.01), and present with metastatic disease (59.8% vs 45%, p = 0.04). Latino patients demonstrated worse survival compared to non-Latino patients in the un-adjusted model (Figure, median survival: 1.1 vs 3.1 years, p < 0.01). After adjusting for both social and oncologic variables, Latino ethnicity remained an independent risk factor for worse survival (HR 1.50, [95% CI 1.03-2.19], p = 0.04).
Conclusion: Latino patients treated within a large, multi-center, safety-net hospital system experience worse survival compared to non-Latinos. These findings suggest that disparities in healthcare access and quality persist within safety-net hospital systems. Improving outcomes for Latino patients with gastric cancer requires a multi-faceted approach aimed at defining and addressing these unidentified barriers to care.
