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- Title
Disparities in access to care at high-volume institutions for uro-oncologic procedures.
- Authors
Trinh, Quoc-Dien; Sun, Maxine; Sammon, Jesse; Bianchi, Marco; Sukumar, Shyam; Ghani, Khurshid R.; Jeong, Wooju; Dabaja, Ali; Shariat, Shahrokh F.; Perrotte, Paul; Agarwal, Piyush K.; Rogers, Craig G.; Peabody, James O.; Menon, Mani; Karakiewicz, Pierre I.
- Abstract
BACKGROUND: Socioeconomic status represents an established barrier to health care access. Age, sex, and race may also play a role. The authors examined whether these affect the access to high-volume hospitals for uro-oncologic procedures in the United States. METHODS: Within the Nationwide Inpatient Sample (NIS), the authors focused on radical prostatectomy (RP), radical cystectomy, and nephrectomy (Nx) performed within the 5 most contemporary years (2003-2007). Logistic regression models were used to estimate the impact of the primary predictors on the likelihood of receiving care at a high-volume hospital. RESULTS: Between 2003 and 2007, 62,165 RP, 6557 radical cystectomy, and 28,062 Nx cases were recorded within the NIS. Patient age ( P = .001), year of surgery ( P = .001), Charlson Comorbidity Index ( P ≤ .025), median Zip Code income (highest vs lowest quartile, P = .001), and insurance status (private vs Medicare, P = .008) were independent predictors of being treated at high-volume institutions. Moreover, black race was an independent predictor of decreased utilization of high-volume institutions for radical cystectomy ( P = .012), and female sex was an independent predictor of decreased utilization of high-volume institutions for Nx ( P = .016). CONCLUSIONS: On average, old, sick, poor, and Medicare patients were less likely to be treated at high-volume hospitals for uro-oncologic surgery. Similarly, black patients were less likely to have a radical cystectomy at a high-volume hospital, and female patients were less likely to have an Nx at a high-volume hospital. Selective referral of individuals who are less likely to receive care at such institutions may represent a health care priority intended to optimize outcomes across all population strata. Cancer 2012. © 2012 American Cancer Society.
- Subjects
ONCOLOGY; SOCIAL status; MEDICAL care; NEPHRECTOMY; AGE differences; HEALTH insurance; COMORBIDITY
- Publication
Cancer (0008543X), 2012, Vol 118, Issue 18, p4421
- ISSN
0008-543X
- Publication type
Article
- DOI
10.1002/cncr.27440