{"paper_id":"4c6fdff0-3f36-4223-b1da-d4c9b2a264da","body_text":"Disparities in Receipt of Palliative Intent Interventions Across Disaggregated Hispanic Subgroups with Late-Stage Colon Cancer in the United States CO-AUTHORS | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Disparities in Receipt of Palliative Intent Interventions Across Disaggregated Hispanic Subgroups with Late-Stage Colon Cancer in the United States CO-AUTHORS Coby Garcia, Shriya Garg, Minji Kwon, Shivaek Venkateswaran, Cody Chou, and 11 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7285328/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract INTRODUCTION Palliative interventions, defined as cancer-directed therapies with palliative intent, improve the quality of life and alleviate suffering for patients with advanced colon cancer. Limited research examines disparities in palliative-intent receipt across disaggregated Hispanic subgroups. We analyzed palliative intervention receipt among Hispanic patients with stage IV colon cancer. METHODS Using the National Cancer Database, we retrospectively analyzed adults diagnosed with stage IV colon cancer (2004–2021) with known palliative intervention receipt status (defined binarily). We performed logistic regressions to characterize palliative intervention receipt rates across a) broad racial groups and b) country of origin, relative to Non-Hispanic White patients (alpha < 0.05). Regressions included a race*year interaction term to examine changes in palliative intervention receipt over time (alpha < 0.1). RESULTS We analyzed 202,073 patients; 12.94% (N = 26,142) received palliative interventions. Hispanic Black patients were 0.55 times as likely (P = 0.030) to receive palliative interventions as non-Hispanic White patients. Multivariable regression revealed significantly lower odds of palliative intervention receipt among several Hispanic subgroups: Puerto Rican patients were 24% less likely (P = 0.040), Cuban patients 30% less likely (P = 0.030), and patients of Hispanic Not Otherwise Specified (NOS) origin were 13% less likely (P < 0.001) to receive care compared to non-Hispanic White patients. When disaggregated by year of diagnosis, a significant time*race interaction was observed for Dominican patients, who were 58% less likely (AOR = 0.42, P = 0.020) to receive palliative care in 2013–2021 compared to 2004–2012, relative to non-Hispanic White patients. These findings highlight persistent and subgroup-specific disparities in the receipt of palliative-intent care among patients with stage IV colon cancer. DISCUSSION Hispanic Black, Puerto Rican, and Cuban patients experienced lower receipt of palliative interventions, revealing disparities in access to equitable cancer-directed end-of-life care. Culturally tailored efforts should be made to expand palliative intervention access for diverse racial/ethnic groups. Figures Figure 1 INTRODUCTION Colorectal cancer (CRC) is the second most common cause of cancer-related mortality in the United States, with a projected 153,020 new cases and 52,550 deaths in 2023. 1 Over 20% of patients are identified at stage IV, with few curative options and a significant disease burden. 2 Patients of Hispanic and Latino ethnicity had greater rates of late-stage diagnosis and received less guideline-concordant treatment compared to patients of non-Hispanic White ethnicity. 3 Despite accounting for roughly 19% of the U.S. population, these groups still face language and structural hurdles to timely cancer treatment and supportive care. 4 , 5 Palliative-intent therapies, which give patients with late-stage cancer respite from symptoms, psychological support, and enhanced quality of life, are critical in the treatment of advanced cancers. Palliative-intent treatments for metastatic CRC may include chemotherapy, radiotherapy to relieve symptoms, endoscopic stenting, pain management, counseling, and other supportive services. 6 Palliative-intent care integration has been linked to fewer hospitalizations, better mood, more patient satisfaction, and, in certain cases, longer survival. 7 , 8 However, access to palliative-intent care remains uneven, especially when stratified by ethnicity, insurance status, and location. While individuals of Hispanic ethnicity represent a growing and diverse U.S. population, little is known about subgroup-specific disparities in access to palliative-intent treatment. Most studies have examined Hispanic patients as a single category, masking important differences among ethnic subgroups. 9 Disaggregated analyses in other racial and ethnic populations (such as Asian Americans and Pacific Islanders) have uncovered significant within-group disparities. 9 , 10 Yet few studies have applied this approach across subgroups of Hispanic patients with advanced cancer, despite vast intergroup heterogeneity with respect to language, socioeconomic status, country of origin, acculturation level, and migration history. While prior studies have examined disparities in receipt of palliative-intent and end-of-life care among broad census-defined racial categories and among disaggregated Asian American subgroups, little is known about within-group disparities among Hispanic populations. This study addresses that gap by disaggregating patients with stage IV colon cancer by Hispanic ethnicity, revealing patterns in palliative-intent treatment receipt that would be masked in aggregate analyses. Specifically, we disaggregated Hispanic ethnicity in patients with stage IV colon cancer using data from the National Cancer Database and examined differences in palliative-intent treatment receipt across self-identified subgroups (such as Mexican, Cuban, Dominican, Puerto Rican). Through this approach, we aim to uncover hidden disparities and inform equity-driven, culturally tailored interventions in end-of-life care. METHODS Cohort Selection We utilized publicly accessible patient-level information from the National Cancer Database (NCDB) to conduct a retrospective cohort study analyzing individuals diagnosed with stage IV colon cancer between 2004 and 2021 to examine racial and ethnic subgroup disparities among Hispanic populations in the receipt of palliative-intent treatments. The NCDB aggregates standardized data from over 1,500 hospitals accredited by the Commission on Cancer across the United States and Puerto Rico. Because this study relied on de-identified NCDB records, institutional review board approval was not required. In the NCDB, palliative-intent treatment is categorized as “any care provided in an effort to palliate or alleviate symptoms,” which may involve surgery, radiation therapy, systemic therapy (chemotherapy, hormone therapy, other systemic treatments), and/or pain management strategies. As the NCDB captures first-line therapies, this variable was used as a stand-in for receipt of early palliative-intent interventions in cases of de novo metastatic setting. For this study, we included all adult individuals aged 18 and older with diagnosed AJCC stage IV colon cancer and a recorded status for palliative-intent treatment. Patients were sorted into racial and ethnic categories based on self-identified race and Hispanic background reported in the NCDB. Hispanic subgroups included Mexican, Puerto Rican, Cuban, Dominican Republic, South or Central American (excluding Brazil), Other Specified Hispanic, and Hispanic Not Otherwise Specified (NOS). Non-Hispanic participants were classified as either Non-Hispanic White or Non-Hispanic Other. Individuals were excluded if their ethnicity was unknown, palliative care data were missing, or if key variables (e.g., insurance coverage or income tier) were incomplete. To examine temporal patterns in palliative-intent care provision, we divided patients into two groups: those diagnosed from 2004 to 2012 and those diagnosed between 2013 and 2021. This stratification allowed us to analyze potential disparities in receipt of palliative interventions across racial and ethnic subgroups while accounting for temporal trends in palliative-intent care delivery. Socioeconomic, Demographic, and Clinical Covariates Our primary dependent variable was defined as the receipt of palliative-intent care. According to the NCDB’s definitions, this pre-defined variable includes any intervention meant to relieve symptoms rather than to diagnose, stage, or treat the primary malignancy directly. Such interventions may include, but are not limited to, surgical procedures, radiotherapy, pharmacologic therapy, and supportive care. However, there is overlap between what the NCDB defines as palliative care and interventions that are life-prolonging or standard-of-care. For instance, systemic chemotherapy in advanced-stage IV colon cancer may simultaneously relieve symptoms and prolong survival. Given the limited size of specific Hispanic subgroups in our data, we focused on disparities in overall access to palliative-intent interventions rather than dissecting specific treatment forms of therapy. To minimize confounding, we adjusted for several key variables: racial/ethnic group (Non-Hispanic White, Non-Hispanic Black, Non-Hispanic Other, Mexican, Puerto Rican, Cuban, Dominican Republic, South or Central American [excluding Brazil], Other Specified Hispanic, and Hispanic Not Otherwise Specified [NOS]), health insurance type, educational background (based on 2016 American Community Survey estimates), income level (from ACS median income quartiles), Charlson-Deyo comorbidity scores, facility characteristics (type and location), and year of diagnosis. This approach allowed for a more nuanced assessment of inequities in palliative care access while accounting for both social determinants and clinical context. Data Analysis In this study, we performed multivariable logistic regression models to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the probability of receiving palliative-intent care. Comparisons were conducted in two sets: (1) between Non-Hispanic White individuals and all Hispanic individuals combined, and (2) between Non-Hispanic White individuals and individual Hispanic subgroups. All models were adjusted for relevant clinical, socioeconomic, and demographic variables. Our analysis was limited to adult patients with AJCC-defined stage IV colon cancer who had documented information on palliative-intent care status. Data and statistical analysis was conducted using Stata/SE version 19. Covariates included in our models were race/ethnicity, insurance status, education, household income, Charlson-Deyo comorbidity index, type of care facility, geographic location of facility, and diagnosis year. To test the robustness of observed differences, we also conducted sensitivity checks to evaluate whether disparities among Hispanic subgroups reached statistical significance (α = 0.05). These analyses provided additional evidence regarding patterns of inequity in the delivery of palliative-intent care. RESULTS Baseline Characteristics of the NCDB Cohort In this retrospective cohort study, we analyzed data from 202,073 patients in the National Cancer Database diagnosed with stage IV colon cancer between 2004 and 2021. The median age at diagnosis was 69 years. The cohort included 150,873 Non-Hispanic White patients (74.66%) and 39,213 Non-Hispanic patients of other races (19.41%). Among patients identified as Hispanic or Spanish origin, the disaggregated breakdown of their countries of origin was as follows: 1,576 patients Mexican origin (0.78%), 582 patients of Puerto Rican origin (0.29%), 484 patients of Cuban origin (0.24%), 749 patients South or Central American (excluding Brazil) origin (0.37%), 270 patients of other specified Spanish/Hispanic origin (0.13%), 7,816 of not otherwise specified (NOS) Hispanic origin (3.87%), 281 identified by Spanish surname only (0.14%), and 229 patients of Dominican origin (0.11%). A total of 12.94% ( N = 26,142) of patients received palliative-intent treatment, and 87.06% of patients ( N = 175,931) did not receive palliative-intended care. Overall, the use of palliative-intent interventions among patients with Stage IV colon cancer remained low, with only 12.94% of the total sample receiving such care. Notably, individuals of Dominican ethnicity had the highest rate of palliative-intent intervention utilization at 16.16%. Several other Hispanic subgroups also demonstrated higher-than-average uptake, including patients of South/Central American (12.68%) or Puerto Rican (11.51%) descent and those categorized as Hispanic Not Otherwise Specified (NOS) (11.21%). In contrast, patients of Cuban descent had the lowest palliative-intent care utilization rate at 8.47%, followed by patients of Mexican descent (10.53%). For comparison, non-Hispanic White patients had a palliative-intent care utilization rate of 13.09% (Table 1 ). These descriptive patterns underscore variation in palliative-intent care across Hispanic origin subgroups within the Stage IV colon cancer population. Disparities in Palliative-Intent Intervention Receipt Among Hispanic Racial/Ethnic Subgroups Variability in the utilization of palliative-intent interventions among the racial subgroups did exist, although the total uptake for the Stage IV sample was 12.94%. Multivariable logistic regression models revealed a significantly decreased utilization of palliative interventions for patients of several Hispanic racial/ethnic groups. Specifically, patients of Puerto Rican descent were 76% as likely (Adjusted Odds Ratio (AOR) = 0.76, 95% Confidence Interval (CI): 0.59–0.99, p = 0.040), Cuban patients were 70% as likely (AOR = 0.70, 95% CI: 0.51–0.97, p = 0.030), and Hispanic NOS patients were 87% as likely to receive palliative-intent intervention relative to Non-Hispanic White patients (AOR = 0.87, 95% CI: 0.81–0.94, p < 0.001). These findings highlight significant disparities in palliative-intent care utilization within specific Hispanic subgroups, even after adjusting for demographic and clinical covariates. When comparing rates of palliative-intent intervention between patients diagnosed between 2004–2012 and those diagnosed between 2013–2021, logistic regression models with interaction terms revealed a significant decrease in the use of palliative-intent interventions for patients of Dominican ethnicity compared to Non-Hispanic White individuals with Stage IV colon cancer (AOR = 0.42, p = 0.020; Table 3 ). This disparity was not detected in the initial model without time stratification, suggesting that temporal differences may mask subgroup-specific gaps in care. No other Hispanic origin subgroup demonstrated a statistically significant change in disparity over time. Table 3 Multivariable Logistic Regression Predicting Palliative-Intent Care Receipt Use among Stage IV Colon Cancer Patients. This data table seeks to identify disparities in the use of palliative-intent interventions that may not have appeared using multivariate logistic regression models without interaction terms. This data uses time stratification (diagnosis year) to show the disparities in palliative-intent intervention usage over time amongst the Hispanic subgroups. Predictor Odds Ratio Std. Error z p-value 95% Confidence Interval Age Group (ref: 18–64) 65–74 0.9351 0.0206 -3.05 0.002 0.8956–0.9763 75–79 0.9469 0.0260 -1.98 0.047 0.8972–0.9994 80+ 0.9390 0.0230 -2.57 0.010 0.8949–0.9852 Hispanic Origin (ref: Non-Hispanic White) Mexican 0.6942 0.1129 -2.25 0.025 0.5048–0.9547 Puerto Rican 0.7136 0.1799 -1.34 0.181 0.4354–1.1695 Cuban 0.7343 0.1708 -1.33 0.184 0.4654–1.1586 South/Central American 0.8198 0.1787 -0.91 0.362 0.5348–1.2566 Other Hispanic 1.0343 0.3024 0.12 0.908 0.5831–1.8346 Hispanic NOS 0.7531 0.0561 -3.81 0.000 0.6508–0.8715 Spanish surname only 0.6917 0.2529 -1.01 0.313 0.3378–1.4162 Dominican Republic 2.0198 0.5969 2.38 0.017 1.1318–3.6046 Non-Hispanic Other 0.9628 0.0298 -1.22 0.221 0.9061–1.0231 Diagnosis Period (ref: 2004–2012) 2013–2021 1.9647 0.0321 41.30 < 0.001 1.9027–2.0286 Interaction: Hispanic Origin × Year Mexican × 2013–2021 1.0328 0.1951 0.17 0.865 0.7132–1.4955 Puerto Rican × 2013–2021 1.1640 0.3436 0.51 0.607 0.6527–2.0759 Cuban × 2013–2021 0.7566 0.2479 -0.85 0.395 0.3981–1.4381 South/Central Am. × 2013–2021 1.1275 0.2854 0.47 0.635 0.6865–1.8519 Other Hispanic × 2013–2021 0.6880 0.2692 -0.96 0.339 0.3196–1.4812 Hispanic NOS × 2013–2021 1.0017 0.0858 0.02 0.984 0.8469–1.1848 Spanish surname × 2013–2021 1.3360 0.5748 0.67 0.501 0.5749–3.1046 Dominican Republic × 2013–2021 0.4209 0.1568 -2.32 0.020 0.2028–0.8735 NH Other × 2013–2021 0.9472 0.0348 -1.48 0.139 0.8814–1.0179 Sex (ref: Male) Female 0.9335 0.0125 -5.12 < 0.001 0.9093–0.9585 Insurance (ref: Uninsured) Private Insurance 0.7551 0.0251 -8.43 < 0.001 0.7074–0.8060 Medicaid 0.9515 0.0363 -1.30 0.192 0.8829–1.0254 Medicare 0.8713 0.0315 -3.81 < 0.001 0.8116–0.9354 Other Government 0.8499 0.0595 -2.32 0.020 0.7409–0.9749 Unknown 0.6204 0.0432 -6.86 < 0.001 0.5412–0.7111 Income Quartile (ref: <$40,227) $ 40,227– $ 50,353 1.0333 0.0211 1.60 0.109 0.9927–1.0756 $ 50,354– $ 63,332 1.0250 0.0210 1.20 0.229 0.9846–1.0671 ≥ $ 63,333 0.9291 0.0180 -3.80 < 0.001 0.8945–0.9651 Facility Type (ref: Community Cancer Program) Comprehensive Community Cancer Program 1.0680 0.0270 2.60 0.009 1.0164–1.1222 Academic/Research Program (includes NCI-designated comprehensive cancer centers) 1.1145 0.0289 4.17 < 0.001 1.0592–1.1727 Integrated Network Cancer Program 1.1804 0.0322 6.07 < 0.001 1.1188–1.2453 Comorbidity Score (ref: 0) 1 1.1300 0.0195 7.10 < 0.001 1.0925–1.1688 2 1.2297 0.0339 7.49 < 0.001 1.1649–1.2980 ≥3 1.2570 0.0407 7.07 < 0.001 1.1798–1.3393 Constant 0.1134 0.0048 -51.25 < 0.001 0.1044–0.1233 Of the interaction terms testing whether disparities changed over time, only patients of Dominican ethnicity showed a statistically significant time-based difference. Patients of Dominican ethnicity were 42% as likely to receive palliative-intent care in 2013–2021 compared to 2004–2012, relative to Non-Hispanic White patients (AOR = 0.42, 95% CI: 0.20–0.87, p = 0.020). No other subgroup showed a significant change in receipt of palliative-intent intervention over time. DISCUSSION This study identifies significant disparities in the use of palliative-intent interventions among disaggregated Hispanic subpopulations diagnosed with stage IV colon cancer. While the overall uptake of palliative-intent care remains low, our findings indicate particularly reduced utilization among specific Hispanic subgroups. After adjustment for clinical and demographic variables, Cuban patients were 70% as likely, Puerto Rican patients were 76% as likely, and patients categorized as Hispanic Not Otherwise Specified (NOS) were 87% as likely to receive palliative-intent interventions compared to non-Hispanic White patients. Notably, patients of Dominican origin experienced a worsening disparity over time, with a marked decline in access to palliative-intent care after 2013. Much of the existing literature on cancer care disparities has analyzed Hispanic populations as a single, aggregated group. This practice has likely obscured important variation across communities that differ substantially in socioeconomic position, migration history, language, and healthcare access. Previous work has demonstrated that Hispanic patients, in aggregate, are less likely to receive palliative-intent care relative to non-Hispanic Whites 11 – 19 . However, our disaggregated analysis reveals subgroup-specific differences that aggregated studies cannot capture. This is consistent with growing calls in the disparities literature to move beyond pan-ethnic categories when assessing health outcomes. Several subgroup-specific factors may explain the patterns observed. Cuban patients may face language discordance and a lack of bilingual providers, barriers that are well documented in limiting access to supportive care 20 – 22 . Specifically, 61.6% of Cuban-born individuals in the U.S. report speaking English less than 'very well,' a rate that exceeds that of most other major immigrant groups, including Colombians (52.5%) and Haitians (53.6%), indicating particularly high rates of limited English proficiency among Cuban communities 23 . In addition to the difficulties of language discordances, Puerto Rican patients, despite U.S. citizenship, often reside in areas with high poverty rates and limited provider availability, which may hinder healthcare engagement; notably, approximately 42% of Puerto Rico's population lives below the federal poverty line 24 . Dominican patients, whose disparity in palliative access appears to be growing, are largely concentrated in high-density immigrant neighborhoods, particularly in New York City, where over 700,000 Dominicans reside, with nearly half living in the Bronx and Washington Heights, areas that are well-documented to face significant provider shortages, long wait times, and fragmented care delivery systems 25 – 27 . Addressing these disparities requires targeted interventions that reflect the distinct barriers facing each group. For Cuban patients, who are the oldest Latino subgroup, with a median age of 40.0 years compared to 29.5 years for Hispanic individuals overall and 37.8 years for the general U.S. population, interventions must address both linguistic and geriatric care needs 28 . In addition to the well-documented language barriers faced by this group, their older age profile increases the likelihood of chronic disease, mobility limitations, and care fragmentation 22 . Various studies have shown that home-based care services have shown particular promise in this context, improving treatment uptake and outcomes 29 – 31 . Expanding interpreter-supported, culturally concordant home-based care may also be especially beneficial for aging Cuban populations. In Puerto Rican communities, to address limited provider availability, can adopt telepalliative care as a potential solution. Studies have shown that telepalliative interventions improve symptom management, patient satisfaction, and alignment with care preferences, while also enabling earlier engagement and reducing emergency care reliance in resource-limited settings 32 – 35 . In Dominican communities, embedding palliative-intent care within trusted community clinics and pairing it with medical-legal partnerships (MLPs) can address these systemic barriers; notably, MLPs have been shown to increase access to housing, Medicaid, and utilities support, needs reported by over 60% of patients served through MLPs, and have reduced emergency department use and readmissions by up to 50% 36 . At a broader level, evidence-based policy interventions are also needed. Community-level investments in culturally tailored patient navigation programs have been effective in other contexts and could be adapted for palliative-intent care 37 . Medicaid reimbursement for home- and community-based palliative services, which has been piloted in several states, may reduce access barriers for low-income populations 38 . At the national level, workforce expansion through initiatives such as the Palliative Care and Hospice Education and Training Act (PCHETA) would help address shortages in linguistically and culturally competent care 39 . Improvements in data infrastructure to support more detailed ethnic identification are also essential to inform policy and track progress. This analysis should be interpreted in light of several limitations. The retrospective nature of the NCDB limits causal inference, and the database does not capture longitudinal engagement with palliative services. We were also unable to account for unmeasured confounders, including patient preferences, provider referral patterns, or community-level variation in palliative infrastructure. Ultimately, this study highlights the value of disaggregated analysis in revealing disparities that may otherwise go unrecognized. Future research should aim to understand the drivers of subgroup-specific disparities in palliative-intent care, and to evaluate the effectiveness of targeted interventions in improving outcomes. By moving toward a more nuanced and equity-oriented approach to cancer care, we can begin to close persistent gaps and ensure that all patients have access to high-quality supportive care. Table 1 Palliative-Intent Care Receipt by Hispanic Country of Origin (Stage IV Only). This table displays the percentage of patients with Stage IV colon cancer who did and did not receive palliative-intent intervention, stratified by Hispanic country of origin. Origin No Palliative-Intent Interventions Palliative-Intent Interventions Total Non-Hispanic White 131,127 / 150,873 (86.91%) 19,746 / 150,873 (13.09%) 150,873 Mexican 1,410 / 1,576 (89.47%) 166 / 1,576 (10.53%) 1,576 Puerto Rican 515 / 582 (88.49%) 67 / 582 (11.51%) 582 Cuban 443 / 484 (91.53%) 41 / 484 (8.47%) 484 South/Central American 654 / 749 (87.32%) 95 / 749 (12.68%) 749 Other Hispanic 240 / 270 (88.89%) 30 / 270 (11.11%) 270 Not Otherwise Specified (NOS) 6,940 / 7,816 (88.79%) 876 / 7,816 (11.21%) 7,816 Spanish Surname Only 250 / 281 (88.97%) 31 / 281 (11.03%) 281 Dominican Republic 192 / 229 (83.84%) 37 / 229 (16.16%) 229 Non-Hispanic Other 34,160 / 39,213 (87.11%) 5,053 / 39,213 (12.89%) 39,213 Total 175,931 / 202,073 (87.06%) 26,142 / 202,073 (12.94%) 202,073 Table 2 Logistic regression predicting palliative-intent care use (Stage IV Patients Only). This data table displays the MVR adjusted odds ratio, standard error, p-value, and 95% Confidence Intervals (CI) for each age group, country of origin, insurance status, income quartile, facility type, facility location, high school degree attainment, and comorbidity index. Reference groups are noted in each title row. Variable Adjusted Odds Ratio Std. Err. z p-value 95% Confidence Interval Age Group (ref: 18–64 years) 65–74 0.9433 0.0209 -2.64 0.008 0.9033–0.9852 75–79 0.9497 0.0263 -1.87 0.062 0.8996–1.0026 80+ 0.9387 0.0232 -2.56 0.011 0.8943–0.9853 Hispanic Origin (ref: Non-Hispanic White) Mexican 0.9288 0.0784 -0.88 0.381 0.7873–1.0958 Puerto Rican 0.7630 0.1004 -2.06 0.040 0.5896–0.9875 Cuban 0.6989 0.1152 -2.17 0.030 0.5060–0.9654 South/Central American 1.0000 0.1116 0.00 1.000 0.8034–1.2446 Other Hispanic 0.8535 0.1669 -0.81 0.418 0.5818–1.2520 Hispanic NOS 0.8738 0.0334 -3.53 0.000 0.8107–0.9419 Spanish surname only 1.0386 0.2001 0.20 0.844 0.7120–1.5152 Dominican Republic 1.0344 0.1883 0.19 0.853 0.7240–1.4779 Non-Hispanic Other 0.9833 0.0178 -0.93 0.353 0.9489–1.0189 Diagnosis Year (ref: 2004–2012) 2013–2021 1.9596 0.0281 46.84 0.000 1.9052–2.0156 Sex (ref: Male) Female 0.9316 0.0125 -5.26 0.000 0.9073–0.9565 Insurance (ref: Uninsured) Private 0.7443 0.0250 -8.81 0.000 0.6970–0.7949 Medicaid 0.9436 0.0364 -1.51 0.132 0.8750–1.0177 Medicare 0.8448 0.0308 -4.63 0.000 0.7866–0.9073 Other Government 0.8454 0.0594 -2.39 0.017 0.7366–0.9703 Insurance Unknown 0.6111 0.0427 -7.05 0.000 0.5329–0.7007 Income Quartile (ref: <$40,227) $ 40,227– $ 50,353 1.0232 0.0223 1.05 0.292 0.9804–1.0679 $ 50,354– $ 63,332 0.9956 0.0234 -0.19 0.852 0.9508–1.0425 ≥ $ 63,333 0.8798 0.0232 -4.85 0.000 0.8355–0.9265 Facility Type (ref: Community Cancer Program) Comprehensive Community Cancer Program 1.0845 0.0276 3.18 0.001 1.0317–1.1400 Academic/Research Program (includes NCI-designated comprehensive cancer centers) 1.0832 0.0284 3.05 0.002 1.0290–1.1402 Integrated Network Cancer Program 1.1770 0.0324 5.91 0.000 1.1151–1.2423 Facility Location (ref: New England) Middle Atlantic 0.7335 0.0227 -10.03 0.000 0.6904–0.7793 South Atlantic 0.6164 0.0188 -15.86 0.000 0.5806–0.6543 East North Central 0.6963 0.0216 -11.65 0.000 0.6551–0.7400 East South Central 0.7961 0.0288 -6.30 0.000 0.7416–0.8547 West North Central 0.8165 0.0286 -5.79 0.000 0.7624–0.8745 West South Central 0.5563 0.0202 -16.11 0.000 0.5180–0.5974 Mountain 0.6597 0.0283 -9.69 0.000 0.6064–0.7176 Pacific 0.4515 0.0158 -22.69 0.000 0.4215–0.4836 % No High School Degree (ref: ≥17.5%) 10.9–17.5% 1.0341 0.0215 1.61 0.107 0.9928–1.0771 6.3–10.8% 1.0976 0.0260 3.93 0.000 1.0478–1.1498 <6.3% 1.1052 0.0307 3.61 0.000 1.0467–1.1670 Charleson-Deyo Comorbidity Index (ref: 0) 1 1.1197 0.0193 6.55 0.000 1.0825–1.1583 2 1.2193 0.0337 7.16 0.000 1.1549–1.2872 ≥3 1.2454 0.0404 6.76 0.000 1.1687–1.3272 Constant 0.1658 0.0084 -35.51 0.000 0.1502–0.1831 Declarations Human Ethics and Consent to Participate Declarations Not applicable. Ethical Approval Not applicable. No identified human participants, human material, or human data were involved in this study. Animal Ethics Not applicable. No animals were used in this study. Patient Consent for Publication Not applicable. No individual patient data or images are included in this manuscript. Conflict of Interest Statement The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding Disclosure This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Data Availability Statement The data that support the findings of this study are available from the corresponding author upon reasonable request. Trial Registration Number Not applicable. This study did not involve a registered clinical trial. Statement of Compliance with Laws The authors confirm that all aspects of this work comply with applicable laws and institutional guidelines. Author Contributions Statement C.G., S.G., M.K., S.V., and C.C. wrote the main manuscript text. C.G. and S.G. conducted statistical analysis and drafted the results. M.K. contributed to the results section; S.V. wrote the introduction; and C.C. authored the discussion. S.W., R.D., E.J.G.F., A.S., M.Ko., S.R., J.W., J.C., and P.I. provided guidance, clinical input, and revisions. E.C.D. and K.K. supervised the project and served as senior mentors. C.G. prepared Figures/Table 1–3. All authors reviewed and approved the final manuscript. References Colorectal Cancer Alliance. ACS releases colorectal cancer estimates for 2024. Colorectal Cancer Alliance. January 23, 2024. Accessed July 20, 2025. https://colorectalcancer.org/article/acs-releases-colorectal-cancer-estimates–2024 Surveillance, Epidemiology, and End Results Program. Cancer of the Colon and Rectum - Cancer Stat Facts. SEER. 2025. Accessed July 20, 2025. https://seer.cancer.gov/statfacts/html/colorect.html Nicot-Cartsonis MS, Digbeu BDE, Raji MA, Kuo YF. Disparities in Late-Stage Breast and Colorectal Cancer Diagnosis Among Hispanic, Non-Hispanic White, and Non-Hispanic Black Patients: a Retrospective Cohort Study of Texas Medicare Beneficiaries. J Racial Ethn Health Disparities . Published online December 27, 2022:1–10. doi: 10.1007/s40615-022-01491–4 Martínez ME, Gomez SL, Tao L, et al. Contribution of clinical and socioeconomic factors to differences in breast cancer subtype and mortality between Hispanic and non-Hispanic white women. Breast Cancer Res Treat . 2017;166(1):185–193. doi: 10.1007/s10549-017-4389-z Reininger BM, Wang J, Fisher-Hoch SP, Boutte A, Vatcheva K, McCormick JB. Non-communicable diseases and preventive health behaviors: a comparison of Hispanics nationally and those living along the US-Mexico border. BMC Public Health . 2015;15:564. doi: 10.1186/s12889-015-1850-y Cervantes A, Adam R, Roselló S, et al. Metastatic colorectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up☆. Ann Oncol . 2023;34(1):10–32. doi: 10.1016/j.annonc.2022.10.003 El-Jawahri A, Greer JA, Pirl WF, et al. Effects of Early Integrated Palliative Care on Caregivers of Patients with Lung and Gastrointestinal Cancer: A Randomized Clinical Trial. The Oncologist . 2017;22(12):1528–1534. doi: 10.1634/theoncologist.2017–0227 Greer JA, Pirl WF, Jackson VA, et al. Effect of early palliative care on chemotherapy use and end-of-life care in patients with metastatic non-small-cell lung cancer. J Clin Oncol Off J Am Soc Clin Oncol . 2012;30(4):394–400. doi: 10.1200/JCO.2011.35.7996 Gomez SL, Glaser SL, Horn-Ross PL, et al. Cancer Research in Asian American, Native Hawaiian, and Pacific Islander Populations: Accelerating Cancer Knowledge by Acknowledging and Leveraging Heterogeneity. Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol . 2014;23(11):2202–2205. doi: 10.1158/1055–9965.EPI–14–0624 Kohli K, Wang S, Garg S, et al. Disparities in Receipt of Chemotherapy at the End of Life among Patients with NSCLC. J Gen Intern Med . Published online March 31, 2025. doi: 10.1007/s11606-025-09479–6 Bazargan M, Bazargan-Hejazi S. Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature. Am J Hosp Palliat Care . 2021;38(6):688–718. doi: 10.1177/1049909120966585 Chong K, Silver SA, Long J, et al. Infrequent Provision of Palliative Care to Patients with Dialysis-Requiring AKI. Clin J Am Soc Nephrol CJASN . 2017;12(11):1744–1752. doi: 10.2215/CJN.00270117 Diaz MM, Guareña LA, Garcia B, et al. A scoping review of end-of-life discussions and palliative care: implications for neurological intensive care among Latinos in the U.S. Lancet Reg Health – Am . 2024;38. doi: 10.1016/j.lana.2024.100873 Digitale JC, Nouri SS, Cohen EL, et al. Differential Use of Outpatient Palliative Care by Demographic and Clinical Characteristics. J Pain Symptom Manage . 2023;66(2):e163-e176. doi: 10.1016/j.jpainsymman.2023.04.007 Fereydooni S, Valdez C, Williams L, Malik D, Mehra S, Judson B. Predisposing, Enabling, and Need Factors Driving Palliative Care Use in Head and Neck Cancer. Otolaryngol–Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg . 2024;171(4):1069–1082. doi: 10.1002/ohn.819 Islam JY, Braithwaite D, Zhang D, Guo Y, Tailor TD, Akinyemiju T. Racial and ethnic inequities of palliative care use among advanced Non-Small cell lung cancer patients in the US. Cancer Med . 2023;12(7):8567–8580. doi: 10.1002/cam4.5538 McKee MN, Palama BK, Hall M, LaBelle JL, Bohr NL, Hoehn KS. Racial and Ethnic Differences in Inpatient Palliative Care for Pediatric Stem Cell Transplant Patients. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc . 2022;23(6):417–424. doi: 10.1097/PCC.0000000000002916 Rubens M, Ramamoorthy V, Saxena A, et al. Inpatient Palliative Care Use Among Critically III Brain Metastasis Patients in the United States. Am J Clin Oncol . 2020;43(11):806–812. doi: 10.1097/COC.0000000000000748 Sohal A, Chaudhry H, Sharma R, et al. Recent Trends in Palliative Care Utilization in Patients With Decompensated Liver Disease: 2016–2020 National Analysis. J Palliat Med . 2024;27(3):335–344. doi: 10.1089/jpm.2023.0367 Anderson LM, Scrimshaw SC, Fullilove MT, Fielding JE, Normand J. Culturally competent healthcare systems: A systematic review. Am J Prev Med . 2003;24(3, Supplement):68–79. doi: 10.1016/S0749–3797(02)00657–8 Castro A, Ruiz E. The effects of nurse practitioner cultural competence on Latina patient satisfaction. J Am Acad Nurse Pract . 2009;21(5):278–286. doi: 10.1111/j.1745–7599.2009.00406.x Flores G. Language Barriers to Health Care in the United States. N Engl J Med . 2006;355(3):229–231. doi: 10.1056/NEJMp058316 Gambino CP, Acosta YD, Grieco EM. English-Speaking Ability of the Foreign-Born Population in the United States: 2012. Published online June 2014. Sánchez JP, Lopez WR. Chronic Factors Contributing to Poorer Health in Puerto Rico. JAMA Netw Open . 2025;8(4):e255652. doi: 10.1001/jamanetworkopen.2025.5652 Ngondwe P, Tefera GM. Barriers and Facilitators of Access to Healthcare Among Immigrants with Disabilities: A Qualitative Meta-Synthesis. Healthcare . 2025;13(3):313. doi: 10.3390/healthcare13030313 Pavilon J, Virgin V. Social Determinants of Immigrants’ Health in New York City: Published online June 2022. Pillai D, Artiga S, Hamel L, et al. Health and Health Care Experiences of Immigrants: The 2023 KFF/LA Times Survey of Immigrants. KFF. September 17, 2023. Accessed July 20, 2025. https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-and-health-care-experiences-of-immigrants-the–2023-kff-la-times-survey-of-immigrants/ Moslimani M, Noe-Bustmamante L, Shah S. Facts on Hispanics of Cuban origin in the United States, 2021. Pew Research Center. August 16, 2023. Accessed July 20, 2025. https://www.pewresearch.org/race-and-ethnicity/fact-sheet/u-s-hispanics-facts-on-cuban-origin-latinos/ Elkan R, Kendrick D, Dewey M, et al. Effectiveness of home based support for older people: systematic review and meta-analysis. BMJ . 2001;323(7315):719–725. doi: 10.1136/bmj.323.7315.719 Federman AD, Brody A, Ritchie CS, et al. Outcomes of home-based primary care for homebound older adults: A randomized clinical trial. J Am Geriatr Soc . 2023;71(2):443–454. doi: 10.1111/jgs.17999 Stall N, Nowaczynski M, Sinha SK. Systematic Review of Outcomes from Home-Based Primary Care Programs for Homebound Older Adults. J Am Geriatr Soc . 2014;62(12):2243–2251. doi: 10.1111/jgs.13088 Greer JA, Trotter C, Jackson V, et al. Comparative effectiveness trial of early palliative care delivered via telehealth versus in person among patients with advanced lung cancer. | Journal of Clinical Oncology. 2024 ASCO Annual Meeting. June 5, 2024. Accessed July 20, 2025. https://ascopubs.org/doi/10.1200/JCO.2024.42.17_suppl.LBA3 Greer JA, Temel JS, El-Jawahri A, et al. Telehealth vs In-Person Early Palliative Care for Patients With Advanced Lung Cancer: A Multisite Randomized Clinical Trial. JAMA . 2024;332(14):1153–1164. doi: 10.1001/jama.2024.13964 Haydon HM, Lotfaliany M, Broadbent A, et al. Telehealth-facilitated palliative care enables more people to die at home: An analysis of clinical outcomes and service activity data. BMC Palliat Care . 2025;24(1):22. doi: 10.1186/s12904-024-01622–0 Hayes Bauer E, Schultz ANØ, Brandt F, Smith AC, Bollig G, Dieperink KB. Patient and families’ perspectives on telepalliative care: A systematic integrative review. Palliat Med . 2024;38(1):42–56. doi: 10.1177/02692163231217146 Sobol M. Friends in Law Places- The Role for Medical-Legal Partnerships in Reshaping the Rural Bar and Bedside. S D Law Rev . Published online 2024:713. doi: 10.70657/sdlr.v69.i3.713 Rhodes RL, Barrett NJ, Ejem DB, et al. A Review of Race and Ethnicity in Hospice and Palliative Medicine Research: Representation Matters. J Pain Symptom Manage . 2022;64(5):e289-e299. doi: 10.1016/j.jpainsymman.2022.07.009 Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med . 2010;363(8):733–742. doi: 10.1056/NEJMoa1000678 Sen. Baldwin T [D W. S.2243–118th Congress (2023–2024): Palliative Care and Hospice Education and Training Act. July 11, 2023. Accessed July 20, 2025. https://www.congress.gov/bill/118th-congress/senate-bill/2243 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-7285328\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":528021715,\"identity\":\"23891854-95c6-4938-96f1-6fa8a828ac88\",\"order_by\":0,\"name\":\"Coby Garcia\",\"email\":\"data:image/png;base64,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\",\"orcid\":\"\",\"institution\":\"Harvard University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Coby\",\"middleName\":\"\",\"lastName\":\"Garcia\",\"suffix\":\"\"},{\"id\":528021717,\"identity\":\"b11d454d-1336-42ff-8033-850b37995441\",\"order_by\":1,\"name\":\"Shriya Garg\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Georgia\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Shriya\",\"middleName\":\"\",\"lastName\":\"Garg\",\"suffix\":\"\"},{\"id\":528021718,\"identity\":\"4a6bb044-ffd7-40f4-9248-824f981789b6\",\"order_by\":2,\"name\":\"Minji Kwon\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Saint Louis University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Minji\",\"middleName\":\"\",\"lastName\":\"Kwon\",\"suffix\":\"\"},{\"id\":528021726,\"identity\":\"c0570b01-638e-4baf-a666-84066ad01fe7\",\"order_by\":3,\"name\":\"Shivaek Venkateswaran\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Pennsylvania\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Shivaek\",\"middleName\":\"\",\"lastName\":\"Venkateswaran\",\"suffix\":\"\"},{\"id\":528021727,\"identity\":\"89539d9b-281f-41bf-a64e-105cd550bad2\",\"order_by\":4,\"name\":\"Cody Chou\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Harvard University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Cody\",\"middleName\":\"\",\"lastName\":\"Chou\",\"suffix\":\"\"},{\"id\":528021728,\"identity\":\"ae90bb3d-0af6-4550-8f82-50236f2f3a0f\",\"order_by\":5,\"name\":\"Stephanie Wang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Harvard University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Stephanie\",\"middleName\":\"\",\"lastName\":\"Wang\",\"suffix\":\"\"},{\"id\":528021729,\"identity\":\"a9f4bfdd-fcc9-4281-ba2c-3d7be87492ff\",\"order_by\":6,\"name\":\"Rushabh Doshi\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Yale School of Medicine\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Rushabh\",\"middleName\":\"\",\"lastName\":\"Doshi\",\"suffix\":\"\"},{\"id\":528021730,\"identity\":\"4d789826-b84c-4d9d-b53a-75fec28612fe\",\"order_by\":7,\"name\":\"Erin Jay G Feliciano\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Ateneo de Manila University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Erin\",\"middleName\":\"Jay G\",\"lastName\":\"Feliciano\",\"suffix\":\"\"},{\"id\":528021731,\"identity\":\"0c966298-0ab4-4866-974c-71c2a3a766f3\",\"order_by\":8,\"name\":\"Asher Shin\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Memorial Sloan Kettering Cancer Center\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Asher\",\"middleName\":\"\",\"lastName\":\"Shin\",\"suffix\":\"\"},{\"id\":528021732,\"identity\":\"c6170840-eff6-4f04-a7af-44443e693511\",\"order_by\":9,\"name\":\"Mahi Kohli\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Memorial Sloan Kettering Cancer Center\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Mahi\",\"middleName\":\"\",\"lastName\":\"Kohli\",\"suffix\":\"\"},{\"id\":528021733,\"identity\":\"60dc8817-9883-4503-a162-611f8b19eb9d\",\"order_by\":10,\"name\":\"Sruthi Ranganathan\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Cambridge\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Sruthi\",\"middleName\":\"\",\"lastName\":\"Ranganathan\",\"suffix\":\"\"},{\"id\":528021734,\"identity\":\"bb019ceb-0fdd-40d0-b136-93a7e489ddc1\",\"order_by\":11,\"name\":\"Jonas Willmann\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Memorial Sloan Kettering Cancer Center\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Jonas\",\"middleName\":\"\",\"lastName\":\"Willmann\",\"suffix\":\"\"},{\"id\":528021735,\"identity\":\"cd5a6d6a-cbbe-4490-be89-f04d7462eb6e\",\"order_by\":12,\"name\":\"Jenny Chen\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Memorial Sloan Kettering Cancer Center\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Jenny\",\"middleName\":\"\",\"lastName\":\"Chen\",\"suffix\":\"\"},{\"id\":528021736,\"identity\":\"a451eefd-6532-4b8e-b620-3e7f096e01e7\",\"order_by\":13,\"name\":\"Puneeth Iyengar\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Memorial Sloan Kettering Cancer Center\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Puneeth\",\"middleName\":\"\",\"lastName\":\"Iyengar\",\"suffix\":\"\"},{\"id\":528021737,\"identity\":\"396bce23-7f74-4a03-b57f-7d090bf8f7a0\",\"order_by\":14,\"name\":\"Edward Christopher Dee\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Memorial Sloan Kettering Cancer Center\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Edward\",\"middleName\":\"Christopher\",\"lastName\":\"Dee\",\"suffix\":\"\"},{\"id\":528021738,\"identity\":\"4b8a83a7-ba94-4a51-bb2d-c38aedbcf1bf\",\"order_by\":15,\"name\":\"Khushi Kohli\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Harvard Medical School\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Khushi\",\"middleName\":\"\",\"lastName\":\"Kohli\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-08-03 20:23:17\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-7285328/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-7285328/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":93556121,\"identity\":\"ba6ab2d3-78f7-4e60-a78e-6737122ee8fd\",\"added_by\":\"auto\",\"created_at\":\"2025-10-15 06:41:18\",\"extension\":\"docx\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":373353,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"DisparitiesinReceiptofPalliativeIntentInterventionsAcrossDisaggregatedHispanicSubgroupswithLateStageColonCancerintheUnitedStates.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7285328/v1/3bc74fc7bb200f7823a617c9.docx\"},{\"id\":93556120,\"identity\":\"34ff8d01-8d76-4bf7-8019-62e42c365cf6\",\"added_by\":\"auto\",\"created_at\":\"2025-10-15 06:41:18\",\"extension\":\"json\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":16765,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"795a6231418b4d388d3cc5689003aeb5.json\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7285328/v1/fc42313a4807b910565bdcea.json\"},{\"id\":93556119,\"identity\":\"d3c7f32c-719e-4adf-b6bc-2236f2d00f73\",\"added_by\":\"auto\",\"created_at\":\"2025-10-15 06:41:18\",\"extension\":\"xml\",\"order_by\":2,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":147667,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"795a6231418b4d388d3cc5689003aeb51enriched.xml\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7285328/v1/196414d8382b3b9bb3089601.xml\"},{\"id\":93556122,\"identity\":\"78f8fdae-217d-485c-a90d-0e2ab66f3038\",\"added_by\":\"auto\",\"created_at\":\"2025-10-15 06:41:18\",\"extension\":\"png\",\"order_by\":4,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":94066,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Onlinefloatimage1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7285328/v1/5cfe997feed402b254ffb64d.png\"},{\"id\":93557285,\"identity\":\"bbbec055-0bb1-4f72-aebc-abe5614688ed\",\"added_by\":\"auto\",\"created_at\":\"2025-10-15 06:49:18\",\"extension\":\"xml\",\"order_by\":5,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":146470,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"795a6231418b4d388d3cc5689003aeb51structuring.xml\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7285328/v1/d8f69fe0547d994c64306eb9.xml\"},{\"id\":93556125,\"identity\":\"044174e1-6e6b-4610-af14-26a8226eb21b\",\"added_by\":\"auto\",\"created_at\":\"2025-10-15 06:41:18\",\"extension\":\"html\",\"order_by\":6,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":159371,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"earlyproof.html\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7285328/v1/1f9a8ee44a6317461e1e9938.html\"},{\"id\":93557284,\"identity\":\"d47d08b9-fe3f-4e6f-bd3a-12b1d98cb3ef\",\"added_by\":\"auto\",\"created_at\":\"2025-10-15 06:49:18\",\"extension\":\"jpeg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":521765,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eThe percentage of patients receiving palliative-intent interventions, stratified by race/ethnicity and diagnosis year. \\u003c/strong\\u003eThis figure illustrates disparities in palliative-intent intervention utilization amongst the different Hispanic subgroups as a whole. Furthermore, this graph visualizes the differences based on the diagnosis year for the patients considered in this study.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage1.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7285328/v1/90a4d89b4a654d6262e85673.jpeg\"},{\"id\":95800535,\"identity\":\"06de7d82-c1f4-4716-8c77-823540dc2f78\",\"added_by\":\"auto\",\"created_at\":\"2025-11-13 08:22:49\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":2190312,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7285328/v1/d965bc65-1ac1-4bb7-a05e-aed30a6f9b20.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Disparities in Receipt of Palliative Intent Interventions Across Disaggregated Hispanic Subgroups with Late-Stage Colon Cancer in the United States CO-AUTHORS\",\"fulltext\":[{\"header\":\"INTRODUCTION\",\"content\":\"\\u003cp\\u003eColorectal cancer (CRC) is the second most common cause of cancer-related mortality in the United States, with a projected 153,020 new cases and 52,550 deaths in 2023.\\u003csup\\u003e\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u003c/sup\\u003e Over 20% of patients are identified at stage IV, with few curative options and a significant disease burden.\\u003csup\\u003e\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e\\u003c/sup\\u003e Patients of Hispanic and Latino ethnicity had greater rates of late-stage diagnosis and received less guideline-concordant treatment compared to patients of non-Hispanic White ethnicity.\\u003csup\\u003e\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u003c/sup\\u003e Despite accounting for roughly 19% of the U.S. population, these groups still face language and structural hurdles to timely cancer treatment and supportive care.\\u003csup\\u003e\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e\\u003cp\\u003ePalliative-intent therapies, which give patients with late-stage cancer respite from symptoms, psychological support, and enhanced quality of life, are critical in the treatment of advanced cancers. Palliative-intent treatments for metastatic CRC may include chemotherapy, radiotherapy to relieve symptoms, endoscopic stenting, pain management, counseling, and other supportive services.\\u003csup\\u003e\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e\\u003c/sup\\u003e Palliative-intent care integration has been linked to fewer hospitalizations, better mood, more patient satisfaction, and, in certain cases, longer survival.\\u003csup\\u003e\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e\\u003c/sup\\u003e However, access to palliative-intent care remains uneven, especially when stratified by ethnicity, insurance status, and location.\\u003c/p\\u003e\\u003cp\\u003eWhile individuals of Hispanic ethnicity represent a growing and diverse U.S. population, little is known about subgroup-specific disparities in access to palliative-intent treatment. Most studies have examined Hispanic patients as a single category, masking important differences among ethnic subgroups.\\u003csup\\u003e\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e\\u003c/sup\\u003e Disaggregated analyses in other racial and ethnic populations (such as Asian Americans and Pacific Islanders) have uncovered significant within-group disparities.\\u003csup\\u003e\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e\\u003c/sup\\u003e Yet few studies have applied this approach across subgroups of Hispanic patients with advanced cancer, despite vast intergroup heterogeneity with respect to language, socioeconomic status, country of origin, acculturation level, and migration history.\\u003c/p\\u003e\\u003cp\\u003eWhile prior studies have examined disparities in receipt of palliative-intent and end-of-life care among broad census-defined racial categories and among disaggregated Asian American subgroups, little is known about within-group disparities among Hispanic populations. This study addresses that gap by disaggregating patients with stage IV colon cancer by Hispanic ethnicity, revealing patterns in palliative-intent treatment receipt that would be masked in aggregate analyses.\\u003c/p\\u003e\\u003cp\\u003eSpecifically, we disaggregated Hispanic ethnicity in patients with stage IV colon cancer using data from the National Cancer Database and examined differences in palliative-intent treatment receipt across self-identified subgroups (such as Mexican, Cuban, Dominican, Puerto Rican). Through this approach, we aim to uncover hidden disparities and inform equity-driven, culturally tailored interventions in end-of-life care.\\u003c/p\\u003e\"},{\"header\":\"METHODS\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eCohort Selection\\u003c/h2\\u003e\\u003cp\\u003eWe utilized publicly accessible patient-level information from the National Cancer Database (NCDB) to conduct a retrospective cohort study analyzing individuals diagnosed with stage IV colon cancer between 2004 and 2021 to examine racial and ethnic subgroup disparities among Hispanic populations in the receipt of palliative-intent treatments. The NCDB aggregates standardized data from over 1,500 hospitals accredited by the Commission on Cancer across the United States and Puerto Rico. Because this study relied on de-identified NCDB records, institutional review board approval was not required.\\u003c/p\\u003e\\u003cp\\u003eIn the NCDB, palliative-intent treatment is categorized as \\u0026ldquo;any care provided in an effort to palliate or alleviate symptoms,\\u0026rdquo; which may involve surgery, radiation therapy, systemic therapy (chemotherapy, hormone therapy, other systemic treatments), and/or pain management strategies. As the NCDB captures first-line therapies, this variable was used as a stand-in for receipt of early palliative-intent interventions in cases of \\u003cem\\u003ede novo\\u003c/em\\u003e metastatic setting.\\u003c/p\\u003e\\u003cp\\u003eFor this study, we included all adult individuals aged 18 and older with diagnosed AJCC stage IV colon cancer and a recorded status for palliative-intent treatment. Patients were sorted into racial and ethnic categories based on self-identified race and Hispanic background reported in the NCDB. Hispanic subgroups included Mexican, Puerto Rican, Cuban, Dominican Republic, South or Central American (excluding Brazil), Other Specified Hispanic, and Hispanic Not Otherwise Specified (NOS). Non-Hispanic participants were classified as either Non-Hispanic White or Non-Hispanic Other. Individuals were excluded if their ethnicity was unknown, palliative care data were missing, or if key variables (e.g., insurance coverage or income tier) were incomplete.\\u003c/p\\u003e\\u003cp\\u003eTo examine temporal patterns in palliative-intent care provision, we divided patients into two groups: those diagnosed from 2004 to 2012 and those diagnosed between 2013 and 2021. This stratification allowed us to analyze potential disparities in receipt of palliative interventions across racial and ethnic subgroups while accounting for temporal trends in palliative-intent care delivery.\\u003c/p\\u003e\\u003c/div\\u003e\\n\\u003ch3\\u003eSocioeconomic, Demographic, and Clinical Covariates\\u003c/h3\\u003e\\n\\u003cp\\u003eOur primary dependent variable was defined as the receipt of palliative-intent care. According to the NCDB\\u0026rsquo;s definitions, this pre-defined variable includes any intervention meant to relieve symptoms rather than to diagnose, stage, or treat the primary malignancy directly. Such interventions may include, but are not limited to, surgical procedures, radiotherapy, pharmacologic therapy, and supportive care.\\u003c/p\\u003e\\u003cp\\u003eHowever, there is overlap between what the NCDB defines as palliative care and interventions that are life-prolonging or standard-of-care. For instance, systemic chemotherapy in advanced-stage IV colon cancer may simultaneously relieve symptoms and prolong survival. Given the limited size of specific Hispanic subgroups in our data, we focused on disparities in overall access to palliative-intent interventions rather than dissecting specific treatment forms of therapy.\\u003c/p\\u003e\\u003cp\\u003eTo minimize confounding, we adjusted for several key variables: racial/ethnic group (Non-Hispanic White, Non-Hispanic Black, Non-Hispanic Other, Mexican, Puerto Rican, Cuban, Dominican Republic, South or Central American [excluding Brazil], Other Specified Hispanic, and Hispanic Not Otherwise Specified [NOS]), health insurance type, educational background (based on 2016 American Community Survey estimates), income level (from ACS median income quartiles), Charlson-Deyo comorbidity scores, facility characteristics (type and location), and year of diagnosis. This approach allowed for a more nuanced assessment of inequities in palliative care access while accounting for both social determinants and clinical context.\\u003c/p\\u003e\\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eData Analysis\\u003c/h2\\u003e\\u003cp\\u003eIn this study, we performed multivariable logistic regression models to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the probability of receiving palliative-intent care. Comparisons were conducted in two sets: (1) between Non-Hispanic White individuals and all Hispanic individuals combined, and (2) between Non-Hispanic White individuals and individual Hispanic subgroups. All models were adjusted for relevant clinical, socioeconomic, and demographic variables.\\u003c/p\\u003e\\u003cp\\u003eOur analysis was limited to adult patients with AJCC-defined stage IV colon cancer who had documented information on palliative-intent care status. Data and statistical analysis was conducted using Stata/SE version 19. Covariates included in our models were race/ethnicity, insurance status, education, household income, Charlson-Deyo comorbidity index, type of care facility, geographic location of facility, and diagnosis year. To test the robustness of observed differences, we also conducted sensitivity checks to evaluate whether disparities among Hispanic subgroups reached statistical significance (α\\u0026thinsp;=\\u0026thinsp;0.05). These analyses provided additional evidence regarding patterns of inequity in the delivery of palliative-intent care.\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"RESULTS\",\"content\":\"\\u003cdiv id=\\\"Sec7\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eBaseline Characteristics of the NCDB Cohort\\u003c/h2\\u003e\\u003cp\\u003eIn this retrospective cohort study, we analyzed data from 202,073 patients in the National Cancer Database diagnosed with stage IV colon cancer between 2004 and 2021. The median age at diagnosis was 69 years.\\u003c/p\\u003e\\u003cp\\u003eThe cohort included 150,873 Non-Hispanic White patients (74.66%) and 39,213 Non-Hispanic patients of other races (19.41%). Among patients identified as Hispanic or Spanish origin, the disaggregated breakdown of their countries of origin was as follows: 1,576 patients Mexican origin (0.78%), 582 patients of Puerto Rican origin (0.29%), 484 patients of Cuban origin (0.24%), 749 patients South or Central American (excluding Brazil) origin (0.37%), 270 patients of other specified Spanish/Hispanic origin (0.13%), 7,816 of not otherwise specified (NOS) Hispanic origin (3.87%), 281 identified by Spanish surname only (0.14%), and 229 patients of Dominican origin (0.11%). A total of 12.94% (\\u003cem\\u003eN\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;26,142) of patients received palliative-intent treatment, and 87.06% of patients (\\u003cem\\u003eN\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;175,931) did not receive palliative-intended care.\\u003c/p\\u003e\\u003cp\\u003eOverall, the use of palliative-intent interventions among patients with Stage IV colon cancer remained low, with only 12.94% of the total sample receiving such care. Notably, individuals of Dominican ethnicity had the highest rate of palliative-intent intervention utilization at 16.16%. Several other Hispanic subgroups also demonstrated higher-than-average uptake, including patients of South/Central American (12.68%) or Puerto Rican (11.51%) descent and those categorized as Hispanic Not Otherwise Specified (NOS) (11.21%). In contrast, patients of Cuban descent had the lowest palliative-intent care utilization rate at 8.47%, followed by patients of Mexican descent (10.53%). For comparison, non-Hispanic White patients had a palliative-intent care utilization rate of 13.09% (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). These descriptive patterns underscore variation in palliative-intent care across Hispanic origin subgroups within the Stage IV colon cancer population.\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eDisparities in Palliative-Intent Intervention Receipt Among Hispanic Racial/Ethnic Subgroups\\u003c/h2\\u003e\\u003cp\\u003eVariability in the utilization of palliative-intent interventions among the racial subgroups did exist, although the total uptake for the Stage IV sample was 12.94%. Multivariable logistic regression models revealed a significantly decreased utilization of palliative interventions for patients of several Hispanic racial/ethnic groups. Specifically, patients of Puerto Rican descent were 76% as likely (Adjusted Odds Ratio (AOR)\\u0026thinsp;=\\u0026thinsp;0.76, 95% Confidence Interval (CI): 0.59\\u0026ndash;0.99, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.040), Cuban patients were 70% as likely (AOR\\u0026thinsp;=\\u0026thinsp;0.70, 95% CI: 0.51\\u0026ndash;0.97, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.030), and Hispanic NOS patients were 87% as likely to receive palliative-intent intervention relative to Non-Hispanic White patients (AOR\\u0026thinsp;=\\u0026thinsp;0.87, 95% CI: 0.81\\u0026ndash;0.94, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). These findings highlight significant disparities in palliative-intent care utilization within specific Hispanic subgroups, even after adjusting for demographic and clinical covariates.\\u003c/p\\u003e\\u003cp\\u003eWhen comparing rates of palliative-intent intervention between patients diagnosed between 2004\\u0026ndash;2012 and those diagnosed between 2013\\u0026ndash;2021, logistic regression models with interaction terms revealed a significant decrease in the use of palliative-intent interventions for patients of Dominican ethnicity compared to Non-Hispanic White individuals with Stage IV colon cancer (AOR\\u0026thinsp;=\\u0026thinsp;0.42, p\\u0026thinsp;=\\u0026thinsp;0.020; Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e). This disparity was not detected in the initial model without time stratification, suggesting that temporal differences may mask subgroup-specific gaps in care. No other Hispanic origin subgroup demonstrated a statistically significant change in disparity over time.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eMultivariable Logistic Regression Predicting Palliative-Intent Care Receipt Use among Stage IV Colon Cancer Patients.\\u003c/b\\u003eThis data table seeks to identify disparities in the use of palliative-intent interventions that may not have appeared using multivariate logistic regression models without interaction terms. This data uses time stratification (diagnosis year) to show the disparities in palliative-intent intervention usage over time amongst the Hispanic subgroups.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"6\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePredictor\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eOdds Ratio\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eStd. Error\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003ez\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003ep-value\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e95% Confidence Interval\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eAge Group (ref: 18\\u0026ndash;64)\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e65\\u0026ndash;74\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.9351\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0206\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-3.05\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.002\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.8956\\u0026ndash;0.9763\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e75\\u0026ndash;79\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.9469\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0260\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-1.98\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.047\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.8972\\u0026ndash;0.9994\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e80+\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.9390\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0230\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-2.57\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.010\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.8949\\u0026ndash;0.9852\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eHispanic Origin (ref: Non-Hispanic White)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMexican\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.6942\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.1129\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-2.25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.025\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.5048\\u0026ndash;0.9547\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePuerto Rican\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.7136\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.1799\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-1.34\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.181\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.4354\\u0026ndash;1.1695\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCuban\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.7343\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.1708\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-1.33\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.184\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.4654\\u0026ndash;1.1586\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSouth/Central American\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.8198\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.1787\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.91\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.362\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.5348\\u0026ndash;1.2566\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eOther Hispanic\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.0343\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.3024\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.908\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.5831\\u0026ndash;1.8346\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eHispanic NOS\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.7531\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0561\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-3.81\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.6508\\u0026ndash;0.8715\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSpanish surname only\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.6917\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.2529\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-1.01\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.313\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.3378\\u0026ndash;1.4162\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eDominican Republic\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2.0198\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.5969\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e2.38\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.017\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.1318\\u0026ndash;3.6046\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNon-Hispanic Other\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.9628\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0298\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-1.22\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.221\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.9061\\u0026ndash;1.0231\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eDiagnosis Period (ref: 2004\\u0026ndash;2012)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e2013\\u0026ndash;2021\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.9647\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0321\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e41.30\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.9027\\u0026ndash;2.0286\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eInteraction: Hispanic Origin \\u0026times; Year\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMexican \\u0026times; 2013\\u0026ndash;2021\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.0328\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.1951\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.17\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.865\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.7132\\u0026ndash;1.4955\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePuerto Rican \\u0026times; 2013\\u0026ndash;2021\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.1640\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.3436\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.51\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.607\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.6527\\u0026ndash;2.0759\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCuban \\u0026times; 2013\\u0026ndash;2021\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.7566\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.2479\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.85\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.395\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.3981\\u0026ndash;1.4381\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSouth/Central Am. \\u0026times; 2013\\u0026ndash;2021\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.1275\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.2854\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.47\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.635\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.6865\\u0026ndash;1.8519\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eOther Hispanic \\u0026times; 2013\\u0026ndash;2021\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.6880\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.2692\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.96\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.339\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.3196\\u0026ndash;1.4812\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eHispanic NOS \\u0026times; 2013\\u0026ndash;2021\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.0017\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0858\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.02\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.984\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.8469\\u0026ndash;1.1848\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSpanish surname \\u0026times; 2013\\u0026ndash;2021\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.3360\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.5748\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.67\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.501\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.5749\\u0026ndash;3.1046\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eDominican Republic \\u0026times; 2013\\u0026ndash;2021\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.4209\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.1568\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-2.32\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.020\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.2028\\u0026ndash;0.8735\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNH Other \\u0026times; 2013\\u0026ndash;2021\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.9472\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0348\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-1.48\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.139\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.8814\\u0026ndash;1.0179\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eSex (ref: Male)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eFemale\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.9335\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0125\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-5.12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.9093\\u0026ndash;0.9585\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eInsurance (ref: Uninsured)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePrivate Insurance\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.7551\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0251\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-8.43\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.7074\\u0026ndash;0.8060\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMedicaid\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.9515\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0363\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-1.30\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.192\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.8829\\u0026ndash;1.0254\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMedicare\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.8713\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0315\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-3.81\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.8116\\u0026ndash;0.9354\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eOther Government\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.8499\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0595\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-2.32\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.020\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.7409\\u0026ndash;0.9749\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eUnknown\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.6204\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0432\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-6.86\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.5412\\u0026ndash;0.7111\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eIncome Quartile (ref: \\u0026lt;$40,227)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cspan\\u003e$\\u003c/span\\u003e40,227\\u0026ndash;\\u003cspan\\u003e$\\u003c/span\\u003e50,353\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.0333\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0211\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.60\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.109\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.9927\\u0026ndash;1.0756\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cspan\\u003e$\\u003c/span\\u003e50,354\\u0026ndash;\\u003cspan\\u003e$\\u003c/span\\u003e63,332\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.0250\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0210\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.20\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.229\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.9846\\u0026ndash;1.0671\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u0026ge;\\u003cspan\\u003e$\\u003c/span\\u003e63,333\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.9291\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0180\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-3.80\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.8945\\u0026ndash;0.9651\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eFacility Type (ref: Community Cancer Program)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eComprehensive Community Cancer Program\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.0680\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0270\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e2.60\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.009\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.0164\\u0026ndash;1.1222\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAcademic/Research Program (includes NCI-designated comprehensive\\u003c/p\\u003e\\u003cp\\u003ecancer centers)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.1145\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0289\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e4.17\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.0592\\u0026ndash;1.1727\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eIntegrated Network Cancer Program\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.1804\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0322\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e6.07\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.1188\\u0026ndash;1.2453\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eComorbidity Score (ref: 0)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.1300\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0195\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e7.10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.0925\\u0026ndash;1.1688\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.2297\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0339\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e7.49\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.1649\\u0026ndash;1.2980\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u0026ge;3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.2570\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0407\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e7.07\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.1798\\u0026ndash;1.3393\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eConstant\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.1134\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0048\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-51.25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.1044\\u0026ndash;0.1233\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eOf the interaction terms testing whether disparities changed over time, only patients of Dominican ethnicity showed a statistically significant time-based difference. Patients of Dominican ethnicity were 42% as likely to receive palliative-intent care in 2013\\u0026ndash;2021 compared to 2004\\u0026ndash;2012, relative to Non-Hispanic White patients (AOR\\u0026thinsp;=\\u0026thinsp;0.42, 95% CI: 0.20\\u0026ndash;0.87, p\\u0026thinsp;=\\u0026thinsp;0.020). No other subgroup showed a significant change in receipt of palliative-intent intervention over time.\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eThis study identifies significant disparities in the use of palliative-intent interventions among disaggregated Hispanic subpopulations diagnosed with stage IV colon cancer. While the overall uptake of palliative-intent care remains low, our findings indicate particularly reduced utilization among specific Hispanic subgroups. After adjustment for clinical and demographic variables, Cuban patients were 70% as likely, Puerto Rican patients were 76% as likely, and patients categorized as Hispanic Not Otherwise Specified (NOS) were 87% as likely to receive palliative-intent interventions compared to non-Hispanic White patients. Notably, patients of Dominican origin experienced a worsening disparity over time, with a marked decline in access to palliative-intent care after 2013.\\u003c/p\\u003e\\u003cp\\u003eMuch of the existing literature on cancer care disparities has analyzed Hispanic populations as a single, aggregated group. This practice has likely obscured important variation across communities that differ substantially in socioeconomic position, migration history, language, and healthcare access. Previous work has demonstrated that Hispanic patients, in aggregate, are less likely to receive palliative-intent care relative to non-Hispanic Whites \\u003csup\\u003e\\u003cspan additionalcitationids=\\\"CR12 CR13 CR14 CR15 CR16 CR17 CR18\\\" citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e\\u003c/sup\\u003e. However, our disaggregated analysis reveals subgroup-specific differences that aggregated studies cannot capture. This is consistent with growing calls in the disparities literature to move beyond pan-ethnic categories when assessing health outcomes.\\u003c/p\\u003e\\u003cp\\u003eSeveral subgroup-specific factors may explain the patterns observed. Cuban patients may face language discordance and a lack of bilingual providers, barriers that are well documented in limiting access to supportive care \\u003csup\\u003e\\u003cspan additionalcitationids=\\\"CR21\\\" citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e\\u003c/sup\\u003e. Specifically, 61.6% of Cuban-born individuals in the U.S. report speaking English less than 'very well,' a rate that exceeds that of most other major immigrant groups, including Colombians (52.5%) and Haitians (53.6%), indicating particularly high rates of limited English proficiency among Cuban communities \\u003csup\\u003e\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cp\\u003eIn addition to the difficulties of language discordances, Puerto Rican patients, despite U.S. citizenship, often reside in areas with high poverty rates and limited provider availability, which may hinder healthcare engagement; notably, approximately 42% of Puerto Rico's population lives below the federal poverty line \\u003csup\\u003e\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e\\u003c/sup\\u003e. Dominican patients, whose disparity in palliative access appears to be growing, are largely concentrated in high-density immigrant neighborhoods, particularly in New York City, where over 700,000 Dominicans reside, with nearly half living in the Bronx and Washington Heights, areas that are well-documented to face significant provider shortages, long wait times, and fragmented care delivery systems \\u003csup\\u003e\\u003cspan additionalcitationids=\\\"CR26\\\" citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cp\\u003eAddressing these disparities requires targeted interventions that reflect the distinct barriers facing each group. For Cuban patients, who are the oldest Latino subgroup, with a median age of 40.0 years compared to 29.5 years for Hispanic individuals overall and 37.8 years for the general U.S. population, interventions must address both linguistic and geriatric care needs \\u003csup\\u003e\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e\\u003c/sup\\u003e. In addition to the well-documented language barriers faced by this group, their older age profile increases the likelihood of chronic disease, mobility limitations, and care fragmentation \\u003csup\\u003e\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e\\u003c/sup\\u003e. Various studies have shown that home-based care services have shown particular promise in this context, improving treatment uptake and outcomes \\u003csup\\u003e\\u003cspan additionalcitationids=\\\"CR30\\\" citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e\\u003c/sup\\u003e. Expanding interpreter-supported, culturally concordant home-based care may also be especially beneficial for aging Cuban populations. In Puerto Rican communities, to address limited provider availability, can adopt telepalliative care as a potential solution. Studies have shown that telepalliative interventions improve symptom management, patient satisfaction, and alignment with care preferences, while also enabling earlier engagement and reducing emergency care reliance in resource-limited settings \\u003csup\\u003e\\u003cspan additionalcitationids=\\\"CR33 CR34\\\" citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e\\u003c/sup\\u003e. In Dominican communities, embedding palliative-intent care within trusted community clinics and pairing it with medical-legal partnerships (MLPs) can address these systemic barriers; notably, MLPs have been shown to increase access to housing, Medicaid, and utilities support, needs reported by over 60% of patients served through MLPs, and have reduced emergency department use and readmissions by up to 50% \\u003csup\\u003e36\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cp\\u003eAt a broader level, evidence-based policy interventions are also needed. Community-level investments in culturally tailored patient navigation programs have been effective in other contexts and could be adapted for palliative-intent care \\u003csup\\u003e\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e\\u003c/sup\\u003e. Medicaid reimbursement for home- and community-based palliative services, which has been piloted in several states, may reduce access barriers for low-income populations \\u003csup\\u003e\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e\\u003c/sup\\u003e. At the national level, workforce expansion through initiatives such as the Palliative Care and Hospice Education and Training Act (PCHETA) would help address shortages in linguistically and culturally competent care \\u003csup\\u003e\\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e\\u003c/sup\\u003e. Improvements in data infrastructure to support more detailed ethnic identification are also essential to inform policy and track progress.\\u003c/p\\u003e\\u003cp\\u003eThis analysis should be interpreted in light of several limitations. The retrospective nature of the NCDB limits causal inference, and the database does not capture longitudinal engagement with palliative services. We were also unable to account for unmeasured confounders, including patient preferences, provider referral patterns, or community-level variation in palliative infrastructure.\\u003c/p\\u003e\\u003cp\\u003eUltimately, this study highlights the value of disaggregated analysis in revealing disparities that may otherwise go unrecognized. Future research should aim to understand the drivers of subgroup-specific disparities in palliative-intent care, and to evaluate the effectiveness of targeted interventions in improving outcomes. By moving toward a more nuanced and equity-oriented approach to cancer care, we can begin to close persistent gaps and ensure that all patients have access to high-quality supportive care.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003ePalliative-Intent Care Receipt by Hispanic Country of Origin (Stage IV Only).\\u003c/b\\u003e This table displays the percentage of patients with Stage IV colon cancer who did and did not receive palliative-intent intervention, stratified by Hispanic country of origin.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"4\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eOrigin\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eNo Palliative-Intent Interventions\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePalliative-Intent Interventions\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eTotal\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNon-Hispanic White\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e131,127 / 150,873 (86.91%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e19,746 / 150,873 (13.09%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e150,873\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMexican\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1,410 / 1,576 (89.47%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e166 / 1,576 (10.53%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1,576\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePuerto Rican\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e515 / 582 (88.49%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e67 / 582 (11.51%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e582\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCuban\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e443 / 484 (91.53%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e41 / 484 (8.47%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e484\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSouth/Central American\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e654 / 749 (87.32%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e95 / 749 (12.68%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e749\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eOther Hispanic\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e240 / 270 (88.89%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e30 / 270 (11.11%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e270\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNot Otherwise Specified (NOS)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e6,940 / 7,816 (88.79%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e876 / 7,816 (11.21%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e7,816\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSpanish Surname Only\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e250 / 281 (88.97%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e31 / 281 (11.03%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e281\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eDominican Republic\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e192 / 229 (83.84%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e37 / 229 (16.16%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e229\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNon-Hispanic Other\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e34,160 / 39,213 (87.11%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e5,053 / 39,213 (12.89%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e39,213\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eTotal\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e175,931 / 202,073 (87.06%)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e26,142 / 202,073 (12.94%)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e202,073\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eLogistic regression predicting palliative-intent care use (Stage IV Patients Only).\\u003c/b\\u003e This data table displays the MVR adjusted odds ratio, standard error, p-value, and 95% Confidence Intervals (CI) for each age group, country of origin, insurance status, income quartile, facility type, facility location, high school degree attainment, and comorbidity index. Reference groups are noted in each title row.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"6\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eVariable\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eAdjusted Odds Ratio\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eStd. Err.\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003ez\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003ep-value\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e95% Confidence Interval\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eAge Group (ref: 18\\u0026ndash;64 years)\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e65\\u0026ndash;74\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.9433\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0209\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-2.64\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.008\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.9033\\u0026ndash;0.9852\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e75\\u0026ndash;79\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.9497\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0263\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-1.87\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.062\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.8996\\u0026ndash;1.0026\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e80+\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.9387\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0232\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-2.56\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.011\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.8943\\u0026ndash;0.9853\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eHispanic Origin (ref: Non-Hispanic White)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMexican\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.9288\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0784\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.88\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.381\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.7873\\u0026ndash;1.0958\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePuerto Rican\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.7630\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.1004\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-2.06\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.040\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.5896\\u0026ndash;0.9875\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCuban\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.6989\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.1152\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-2.17\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.030\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.5060\\u0026ndash;0.9654\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSouth/Central American\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.0000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.1116\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.8034\\u0026ndash;1.2446\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eOther Hispanic\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.8535\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.1669\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.81\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.418\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.5818\\u0026ndash;1.2520\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eHispanic NOS\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.8738\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0334\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-3.53\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.8107\\u0026ndash;0.9419\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSpanish surname only\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.0386\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.2001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.20\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.844\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.7120\\u0026ndash;1.5152\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eDominican Republic\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.0344\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.1883\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.19\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.853\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.7240\\u0026ndash;1.4779\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNon-Hispanic Other\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.9833\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0178\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.93\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.353\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.9489\\u0026ndash;1.0189\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eDiagnosis Year (ref: 2004\\u0026ndash;2012)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e2013\\u0026ndash;2021\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.9596\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0281\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e46.84\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.9052\\u0026ndash;2.0156\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eSex (ref: Male)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eFemale\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.9316\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0125\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-5.26\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.9073\\u0026ndash;0.9565\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eInsurance (ref: Uninsured)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePrivate\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.7443\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0250\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-8.81\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.6970\\u0026ndash;0.7949\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMedicaid\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.9436\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0364\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-1.51\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.132\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.8750\\u0026ndash;1.0177\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMedicare\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.8448\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0308\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-4.63\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.7866\\u0026ndash;0.9073\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eOther Government\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.8454\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0594\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-2.39\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.017\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.7366\\u0026ndash;0.9703\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eInsurance Unknown\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.6111\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0427\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-7.05\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.5329\\u0026ndash;0.7007\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eIncome Quartile (ref: \\u0026lt;$40,227)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cspan\\u003e$\\u003c/span\\u003e40,227\\u0026ndash;\\u003cspan\\u003e$\\u003c/span\\u003e50,353\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.0232\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0223\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.05\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.292\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.9804\\u0026ndash;1.0679\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cspan\\u003e$\\u003c/span\\u003e50,354\\u0026ndash;\\u003cspan\\u003e$\\u003c/span\\u003e63,332\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.9956\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0234\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.19\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.852\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.9508\\u0026ndash;1.0425\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u0026ge;\\u003cspan\\u003e$\\u003c/span\\u003e63,333\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.8798\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0232\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-4.85\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.8355\\u0026ndash;0.9265\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eFacility Type (ref: Community Cancer Program)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eComprehensive Community Cancer Program\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.0845\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0276\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e3.18\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.0317\\u0026ndash;1.1400\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAcademic/Research Program (includes NCI-designated comprehensive\\u003c/p\\u003e\\u003cp\\u003ecancer centers)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.0832\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0284\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e3.05\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.002\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.0290\\u0026ndash;1.1402\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eIntegrated Network Cancer Program\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.1770\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0324\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e5.91\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.1151\\u0026ndash;1.2423\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eFacility Location (ref: New England)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMiddle Atlantic\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.7335\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0227\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-10.03\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.6904\\u0026ndash;0.7793\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSouth Atlantic\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.6164\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0188\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-15.86\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.5806\\u0026ndash;0.6543\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eEast North Central\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.6963\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0216\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-11.65\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.6551\\u0026ndash;0.7400\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eEast South Central\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.7961\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0288\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-6.30\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.7416\\u0026ndash;0.8547\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eWest North Central\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.8165\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0286\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-5.79\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.7624\\u0026ndash;0.8745\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eWest South Central\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.5563\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0202\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-16.11\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.5180\\u0026ndash;0.5974\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMountain\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.6597\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0283\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-9.69\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.6064\\u0026ndash;0.7176\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePacific\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.4515\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0158\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-22.69\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.4215\\u0026ndash;0.4836\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e% No High School Degree (ref: \\u0026ge;17.5%)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e10.9\\u0026ndash;17.5%\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.0341\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0215\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.61\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.107\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.9928\\u0026ndash;1.0771\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e6.3\\u0026ndash;10.8%\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.0976\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0260\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e3.93\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.0478\\u0026ndash;1.1498\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u0026lt;6.3%\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.1052\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0307\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e3.61\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.0467\\u0026ndash;1.1670\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eCharleson-Deyo Comorbidity Index (ref: 0)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.1197\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0193\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e6.55\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.0825\\u0026ndash;1.1583\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.2193\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0337\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e7.16\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.1549\\u0026ndash;1.2872\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u0026ge;3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.2454\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0404\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e6.76\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.1687\\u0026ndash;1.3272\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eConstant\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.1658\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.0084\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-35.51\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.1502\\u0026ndash;0.1831\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eHuman Ethics and Consent to Participate Declarations\\u003cbr\\u003e\\u003c/strong\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthical Approval\\u003cbr\\u003e\\u003c/strong\\u003eNot applicable. No identified human participants, human material, or human data were involved in this study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAnimal Ethics\\u003cbr\\u003e\\u003c/strong\\u003eNot applicable. No animals were used in this study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003ePatient Consent for Publication\\u003cbr\\u003e\\u003c/strong\\u003eNot applicable. No individual patient data or images are included in this manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConflict of Interest Statement\\u003cbr\\u003e\\u003c/strong\\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding Disclosure\\u003cbr\\u003e\\u003c/strong\\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData Availability Statement\\u003cbr\\u003e\\u003c/strong\\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTrial Registration Number\\u003cbr\\u003e\\u003c/strong\\u003eNot applicable. This study did not involve a registered clinical trial.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStatement of Compliance with Laws\\u003cbr\\u003e\\u003c/strong\\u003eThe authors confirm that all aspects of this work comply with applicable laws and institutional guidelines.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor Contributions Statement\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eC.G., S.G., M.K., S.V., and C.C. wrote the main manuscript text. C.G. and S.G. conducted statistical analysis and drafted the results. M.K. contributed to the results section; S.V. wrote the introduction; and C.C. authored the discussion. S.W., R.D., E.J.G.F., A.S., M.Ko., S.R., J.W., J.C., and P.I. provided guidance, clinical input, and revisions. E.C.D. and K.K. supervised the project and served as senior mentors. C.G. prepared Figures/Table 1\\u0026ndash;3. All authors reviewed and approved the final manuscript.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eColorectal Cancer Alliance. ACS releases colorectal cancer estimates for 2024. Colorectal Cancer Alliance. January 23, 2024. Accessed July 20, 2025. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://colorectalcancer.org/article/acs-releases-colorectal-cancer-estimates\\u0026ndash;2024\\u003c/span\\u003e\\u003cspan address=\\\"https://colorectalcancer.org/article/acs-releases-colorectal-cancer-estimates\\u0026ndash;2024\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSurveillance, Epidemiology, and End Results Program. Cancer of the Colon and Rectum - Cancer Stat Facts. SEER. 2025. Accessed July 20, 2025. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://seer.cancer.gov/statfacts/html/colorect.html\\u003c/span\\u003e\\u003cspan address=\\\"https://seer.cancer.gov/statfacts/html/colorect.html\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eNicot-Cartsonis MS, Digbeu BDE, Raji MA, Kuo YF. Disparities in Late-Stage Breast and Colorectal Cancer Diagnosis Among Hispanic, Non-Hispanic White, and Non-Hispanic Black Patients: a Retrospective Cohort Study of Texas Medicare Beneficiaries. \\u003cem\\u003eJ Racial Ethn Health Disparities\\u003c/em\\u003e. Published online December 27, 2022:1\\u0026ndash;10. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s40615-022-01491\\u0026ndash;4\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s40615-022-01491\\u0026ndash;4\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMart\\u0026iacute;nez ME, Gomez SL, Tao L, et al. Contribution of clinical and socioeconomic factors to differences in breast cancer subtype and mortality between Hispanic and non-Hispanic white women. \\u003cem\\u003eBreast Cancer Res Treat\\u003c/em\\u003e. 2017;166(1):185\\u0026ndash;193. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s10549-017-4389-z\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s10549-017-4389-z\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eReininger BM, Wang J, Fisher-Hoch SP, Boutte A, Vatcheva K, McCormick JB. Non-communicable diseases and preventive health behaviors: a comparison of Hispanics nationally and those living along the US-Mexico border. \\u003cem\\u003eBMC Public Health\\u003c/em\\u003e. 2015;15:564. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1186/s12889-015-1850-y\\u003c/span\\u003e\\u003cspan address=\\\"10.1186/s12889-015-1850-y\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eCervantes A, Adam R, Rosell\\u0026oacute; S, et al. Metastatic colorectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up☆. \\u003cem\\u003eAnn Oncol\\u003c/em\\u003e. 2023;34(1):10\\u0026ndash;32. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/j.annonc.2022.10.003\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.annonc.2022.10.003\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eEl-Jawahri A, Greer JA, Pirl WF, et al. Effects of Early Integrated Palliative Care on Caregivers of Patients with Lung and Gastrointestinal Cancer: A Randomized Clinical Trial. \\u003cem\\u003eThe Oncologist\\u003c/em\\u003e. 2017;22(12):1528\\u0026ndash;1534. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1634/theoncologist.2017\\u0026ndash;0227\\u003c/span\\u003e\\u003cspan address=\\\"10.1634/theoncologist.2017\\u0026ndash;0227\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eGreer JA, Pirl WF, Jackson VA, et al. Effect of early palliative care on chemotherapy use and end-of-life care in patients with metastatic non-small-cell lung cancer. \\u003cem\\u003eJ Clin Oncol Off J Am Soc Clin Oncol\\u003c/em\\u003e. 2012;30(4):394\\u0026ndash;400. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1200/JCO.2011.35.7996\\u003c/span\\u003e\\u003cspan address=\\\"10.1200/JCO.2011.35.7996\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eGomez SL, Glaser SL, Horn-Ross PL, et al. Cancer Research in Asian American, Native Hawaiian, and Pacific Islander Populations: Accelerating Cancer Knowledge by Acknowledging and Leveraging Heterogeneity. \\u003cem\\u003eCancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol\\u003c/em\\u003e. 2014;23(11):2202\\u0026ndash;2205. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1158/1055\\u0026ndash;9965.EPI\\u0026ndash;14\\u0026ndash;0624\\u003c/span\\u003e\\u003cspan address=\\\"10.1158/1055\\u0026ndash;9965.EPI\\u0026ndash;14\\u0026ndash;0624\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eKohli K, Wang S, Garg S, et al. Disparities in Receipt of Chemotherapy at the End of Life among Patients with NSCLC. \\u003cem\\u003eJ Gen Intern Med\\u003c/em\\u003e. Published online March 31, 2025. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s11606-025-09479\\u0026ndash;6\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s11606-025-09479\\u0026ndash;6\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eBazargan M, Bazargan-Hejazi S. Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature. \\u003cem\\u003eAm J Hosp Palliat Care\\u003c/em\\u003e. 2021;38(6):688\\u0026ndash;718. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1177/1049909120966585\\u003c/span\\u003e\\u003cspan address=\\\"10.1177/1049909120966585\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eChong K, Silver SA, Long J, et al. Infrequent Provision of Palliative Care to Patients with Dialysis-Requiring AKI. \\u003cem\\u003eClin J Am Soc Nephrol CJASN\\u003c/em\\u003e. 2017;12(11):1744\\u0026ndash;1752. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.2215/CJN.00270117\\u003c/span\\u003e\\u003cspan address=\\\"10.2215/CJN.00270117\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eDiaz MM, Guare\\u0026ntilde;a LA, Garcia B, et al. A scoping review of end-of-life discussions and palliative care: implications for neurological intensive care among Latinos in the U.S. \\u003cem\\u003eLancet Reg Health \\u0026ndash; Am\\u003c/em\\u003e. 2024;38. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/j.lana.2024.100873\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.lana.2024.100873\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eDigitale JC, Nouri SS, Cohen EL, et al. Differential Use of Outpatient Palliative Care by Demographic and Clinical Characteristics. \\u003cem\\u003eJ Pain Symptom Manage\\u003c/em\\u003e. 2023;66(2):e163-e176. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/j.jpainsymman.2023.04.007\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.jpainsymman.2023.04.007\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eFereydooni S, Valdez C, Williams L, Malik D, Mehra S, Judson B. Predisposing, Enabling, and Need Factors Driving Palliative Care Use in Head and Neck Cancer. \\u003cem\\u003eOtolaryngol\\u0026ndash;Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg\\u003c/em\\u003e. 2024;171(4):1069\\u0026ndash;1082. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1002/ohn.819\\u003c/span\\u003e\\u003cspan address=\\\"10.1002/ohn.819\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eIslam JY, Braithwaite D, Zhang D, Guo Y, Tailor TD, Akinyemiju T. Racial and ethnic inequities of palliative care use among advanced Non-Small cell lung cancer patients in the US. \\u003cem\\u003eCancer Med\\u003c/em\\u003e. 2023;12(7):8567\\u0026ndash;8580. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1002/cam4.5538\\u003c/span\\u003e\\u003cspan address=\\\"10.1002/cam4.5538\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMcKee MN, Palama BK, Hall M, LaBelle JL, Bohr NL, Hoehn KS. Racial and Ethnic Differences in Inpatient Palliative Care for Pediatric Stem Cell Transplant Patients. \\u003cem\\u003ePediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc\\u003c/em\\u003e. 2022;23(6):417\\u0026ndash;424. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1097/PCC.0000000000002916\\u003c/span\\u003e\\u003cspan address=\\\"10.1097/PCC.0000000000002916\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eRubens M, Ramamoorthy V, Saxena A, et al. Inpatient Palliative Care Use Among Critically III Brain Metastasis Patients in the United States. \\u003cem\\u003eAm J Clin Oncol\\u003c/em\\u003e. 2020;43(11):806\\u0026ndash;812. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1097/COC.0000000000000748\\u003c/span\\u003e\\u003cspan address=\\\"10.1097/COC.0000000000000748\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSohal A, Chaudhry H, Sharma R, et al. Recent Trends in Palliative Care Utilization in Patients With Decompensated Liver Disease: 2016\\u0026ndash;2020 National Analysis. \\u003cem\\u003eJ Palliat Med\\u003c/em\\u003e. 2024;27(3):335\\u0026ndash;344. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1089/jpm.2023.0367\\u003c/span\\u003e\\u003cspan address=\\\"10.1089/jpm.2023.0367\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eAnderson LM, Scrimshaw SC, Fullilove MT, Fielding JE, Normand J. Culturally competent healthcare systems: A systematic review. \\u003cem\\u003eAm J Prev Med\\u003c/em\\u003e. 2003;24(3, Supplement):68\\u0026ndash;79. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/S0749\\u0026ndash;3797(02)00657\\u0026ndash;8\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/S0749\\u0026ndash;3797(02)00657\\u0026ndash;8\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eCastro A, Ruiz E. The effects of nurse practitioner cultural competence on Latina patient satisfaction. \\u003cem\\u003eJ Am Acad Nurse Pract\\u003c/em\\u003e. 2009;21(5):278\\u0026ndash;286. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1111/j.1745\\u0026ndash;7599.2009.00406.x\\u003c/span\\u003e\\u003cspan address=\\\"10.1111/j.1745\\u0026ndash;7599.2009.00406.x\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eFlores G. Language Barriers to Health Care in the United States. \\u003cem\\u003eN Engl J Med\\u003c/em\\u003e. 2006;355(3):229\\u0026ndash;231. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1056/NEJMp058316\\u003c/span\\u003e\\u003cspan address=\\\"10.1056/NEJMp058316\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eGambino CP, Acosta YD, Grieco EM. English-Speaking Ability of the Foreign-Born Population in the United States: 2012. Published online June 2014.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eS\\u0026aacute;nchez JP, Lopez WR. Chronic Factors Contributing to Poorer Health in Puerto Rico. \\u003cem\\u003eJAMA Netw Open\\u003c/em\\u003e. 2025;8(4):e255652. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1001/jamanetworkopen.2025.5652\\u003c/span\\u003e\\u003cspan address=\\\"10.1001/jamanetworkopen.2025.5652\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eNgondwe P, Tefera GM. Barriers and Facilitators of Access to Healthcare Among Immigrants with Disabilities: A Qualitative Meta-Synthesis. \\u003cem\\u003eHealthcare\\u003c/em\\u003e. 2025;13(3):313. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3390/healthcare13030313\\u003c/span\\u003e\\u003cspan address=\\\"10.3390/healthcare13030313\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003ePavilon J, Virgin V. Social Determinants of Immigrants\\u0026rsquo; Health in New York City: Published online June 2022.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003ePillai D, Artiga S, Hamel L, et al. Health and Health Care Experiences of Immigrants: The 2023 KFF/LA Times Survey of Immigrants. KFF. September 17, 2023. Accessed July 20, 2025. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.kff.org/racial-equity-and-health-policy/issue-brief/health-and-health-care-experiences-of-immigrants-the\\u0026ndash;2023-kff-la-times-survey-of-immigrants/\\u003c/span\\u003e\\u003cspan address=\\\"https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-and-health-care-experiences-of-immigrants-the\\u0026ndash;2023-kff-la-times-survey-of-immigrants/\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMoslimani M, Noe-Bustmamante L, Shah S. Facts on Hispanics of Cuban origin in the United States, 2021. Pew Research Center. August 16, 2023. Accessed July 20, 2025. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.pewresearch.org/race-and-ethnicity/fact-sheet/u-s-hispanics-facts-on-cuban-origin-latinos/\\u003c/span\\u003e\\u003cspan address=\\\"https://www.pewresearch.org/race-and-ethnicity/fact-sheet/u-s-hispanics-facts-on-cuban-origin-latinos/\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eElkan R, Kendrick D, Dewey M, et al. Effectiveness of home based support for older people: systematic review and meta-analysis. \\u003cem\\u003eBMJ\\u003c/em\\u003e. 2001;323(7315):719\\u0026ndash;725. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1136/bmj.323.7315.719\\u003c/span\\u003e\\u003cspan address=\\\"10.1136/bmj.323.7315.719\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eFederman AD, Brody A, Ritchie CS, et al. Outcomes of home-based primary care for homebound older adults: A randomized clinical trial. \\u003cem\\u003eJ Am Geriatr Soc\\u003c/em\\u003e. 2023;71(2):443\\u0026ndash;454. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1111/jgs.17999\\u003c/span\\u003e\\u003cspan address=\\\"10.1111/jgs.17999\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eStall N, Nowaczynski M, Sinha SK. Systematic Review of Outcomes from Home-Based Primary Care Programs for Homebound Older Adults. \\u003cem\\u003eJ Am Geriatr Soc\\u003c/em\\u003e. 2014;62(12):2243\\u0026ndash;2251. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1111/jgs.13088\\u003c/span\\u003e\\u003cspan address=\\\"10.1111/jgs.13088\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eGreer JA, Trotter C, Jackson V, et al. Comparative effectiveness trial of early palliative care delivered via telehealth versus in person among patients with advanced lung cancer. | Journal of Clinical Oncology. 2024 ASCO Annual Meeting. June 5, 2024. Accessed July 20, 2025. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://ascopubs.org/doi/10.1200/JCO.2024.42.17_suppl.LBA3\\u003c/span\\u003e\\u003cspan address=\\\"https://ascopubs.doi/10.1200/JCO.2024.42.17_suppl.LBA3\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eGreer JA, Temel JS, El-Jawahri A, et al. Telehealth vs In-Person Early Palliative Care for Patients With Advanced Lung Cancer: A Multisite Randomized Clinical Trial. \\u003cem\\u003eJAMA\\u003c/em\\u003e. 2024;332(14):1153\\u0026ndash;1164. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1001/jama.2024.13964\\u003c/span\\u003e\\u003cspan address=\\\"10.1001/jama.2024.13964\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eHaydon HM, Lotfaliany M, Broadbent A, et al. Telehealth-facilitated palliative care enables more people to die at home: An analysis of clinical outcomes and service activity data. \\u003cem\\u003eBMC Palliat Care\\u003c/em\\u003e. 2025;24(1):22. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1186/s12904-024-01622\\u0026ndash;0\\u003c/span\\u003e\\u003cspan address=\\\"10.1186/s12904-024-01622\\u0026ndash;0\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eHayes Bauer E, Schultz AN\\u0026Oslash;, Brandt F, Smith AC, Bollig G, Dieperink KB. Patient and families\\u0026rsquo; perspectives on telepalliative care: A systematic integrative review. \\u003cem\\u003ePalliat Med\\u003c/em\\u003e. 2024;38(1):42\\u0026ndash;56. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1177/02692163231217146\\u003c/span\\u003e\\u003cspan address=\\\"10.1177/02692163231217146\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSobol M. Friends in Law Places- The Role for Medical-Legal Partnerships in Reshaping the Rural Bar and Bedside. \\u003cem\\u003eS D Law Rev\\u003c/em\\u003e. Published online 2024:713. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.70657/sdlr.v69.i3.713\\u003c/span\\u003e\\u003cspan address=\\\"10.70657/sdlr.v69.i3.713\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eRhodes RL, Barrett NJ, Ejem DB, et al. A Review of Race and Ethnicity in Hospice and Palliative Medicine Research: Representation Matters. \\u003cem\\u003eJ Pain Symptom Manage\\u003c/em\\u003e. 2022;64(5):e289-e299. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/j.jpainsymman.2022.07.009\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.jpainsymman.2022.07.009\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eTemel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. \\u003cem\\u003eN Engl J Med\\u003c/em\\u003e. 2010;363(8):733\\u0026ndash;742. doi:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1056/NEJMoa1000678\\u003c/span\\u003e\\u003cspan address=\\\"10.1056/NEJMoa1000678\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSen. Baldwin T [D W. S.2243\\u0026ndash;118th Congress (2023\\u0026ndash;2024): Palliative Care and Hospice Education and Training Act. July 11, 2023. Accessed July 20, 2025. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.congress.gov/bill/118th-congress/senate-bill/2243\\u003c/span\\u003e\\u003cspan address=\\\"https://www.congress.gov/bill/118th-congress/senate-bill/2243\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7285328/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7285328/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eINTRODUCTION\\u003c/h2\\u003e\\u003cp\\u003ePalliative interventions, defined as cancer-directed therapies with palliative intent, improve the quality of life and alleviate suffering for patients with advanced colon cancer. Limited research examines disparities in palliative-intent receipt across disaggregated Hispanic subgroups. We analyzed palliative intervention receipt among Hispanic patients with stage IV colon cancer.\\u003c/p\\u003e\\u003ch2\\u003eMETHODS\\u003c/h2\\u003e\\u003cp\\u003eUsing the National Cancer Database, we retrospectively analyzed adults diagnosed with stage IV colon cancer (2004\\u0026ndash;2021) with known palliative intervention receipt status (defined binarily). We performed logistic regressions to characterize palliative intervention receipt rates across a) broad racial groups and b) country of origin, relative to Non-Hispanic White patients (alpha\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). Regressions included a race*year interaction term to examine changes in palliative intervention receipt over time (alpha\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.1).\\u003c/p\\u003e\\u003ch2\\u003eRESULTS\\u003c/h2\\u003e\\u003cp\\u003eWe analyzed 202,073 patients; 12.94% (N\\u0026thinsp;=\\u0026thinsp;26,142) received palliative interventions. Hispanic Black patients were 0.55 times as likely (P\\u0026thinsp;=\\u0026thinsp;0.030) to receive palliative interventions as non-Hispanic White patients. Multivariable regression revealed significantly lower odds of palliative intervention receipt among several Hispanic subgroups: Puerto Rican patients were 24% less likely (P\\u0026thinsp;=\\u0026thinsp;0.040), Cuban patients 30% less likely (P\\u0026thinsp;=\\u0026thinsp;0.030), and patients of Hispanic Not Otherwise Specified (NOS) origin were 13% less likely (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) to receive care compared to non-Hispanic White patients. When disaggregated by year of diagnosis, a significant time*race interaction was observed for Dominican patients, who were 58% less likely (AOR\\u0026thinsp;=\\u0026thinsp;0.42, P\\u0026thinsp;=\\u0026thinsp;0.020) to receive palliative care in 2013\\u0026ndash;2021 compared to 2004\\u0026ndash;2012, relative to non-Hispanic White patients. These findings highlight persistent and subgroup-specific disparities in the receipt of palliative-intent care among patients with stage IV colon cancer.\\u003c/p\\u003e\\u003ch2\\u003eDISCUSSION\\u003c/h2\\u003e\\u003cp\\u003eHispanic Black, Puerto Rican, and Cuban patients experienced lower receipt of palliative interventions, revealing disparities in access to equitable cancer-directed end-of-life care. Culturally tailored efforts should be made to expand palliative intervention access for diverse racial/ethnic groups.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Disparities in Receipt of Palliative Intent Interventions Across Disaggregated Hispanic Subgroups with Late-Stage Colon Cancer in the United States CO-AUTHORS\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-10-15 06:41:14\",\"doi\":\"10.21203/rs.3.rs-7285328/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"d07dfcab-2423-4252-aa62-31132c179050\",\"owner\":[],\"postedDate\":\"October 15th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-11-12T07:09:04+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-10-15 06:41:14\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7285328\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7285328\",\"identity\":\"rs-7285328\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}