Original Article

Disparities in access to care at high-volume institutions for uro-oncologic procedures

  1. Quoc-Dien Trinh MD1,2,†,*,
  2. Maxine Sun BSc2,
  3. Jesse Sammon DO1,
  4. Marco Bianchi MD2,
  5. Shyam Sukumar MD1,
  6. Khurshid R. Ghani MD1,
  7. Wooju Jeong MD1,
  8. Ali Dabaja MD1,
  9. Shahrokh F. Shariat MD3,
  10. Paul Perrotte MD2,
  11. Piyush K. Agarwal MD1,
  12. Craig G. Rogers MD1,
  13. James O. Peabody MD1,
  14. Mani Menon MD1,
  15. Pierre I. Karakiewicz MD2

Article first published online: 1 FEB 2012

DOI: 10.1002/cncr.27440

Issue

Cancer

Cancer

Volume 118, Issue 18, pages 4421–4426, 15 September 2012

Additional Information

How to Cite

Trinh, Q.-D., Sun, M., Sammon, J., Bianchi, M., Sukumar, S., Ghani, K. R., Jeong, W., Dabaja, A., Shariat, S. F., Perrotte, P., Agarwal, P. K., Rogers, C. G., Peabody, J. O., Menon, M. and Karakiewicz, P. I. (2012), Disparities in access to care at high-volume institutions for uro-oncologic procedures. Cancer, 118: 4421–4426. doi: 10.1002/cncr.27440

Author Information

  1. 1

    Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan

  2. 2

    Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada

  3. 3

    Department of Urology, Weill Medical College of Cornell University, New York, New York

  1. †

    Fax: (514) 227-5103

*Vattikuti Urology Institute, Henry Ford Health System, 2799 W. Grand Boulevard, Detroit, MI 48202

  1. †

    Fax: (514) 227-5103

Publication History

  1. Issue published online: 5 SEP 2012
  2. Article first published online: 1 FEB 2012
  3. Manuscript Accepted: 13 DEC 2011
  4. Manuscript Revised: 2 NOV 2011
  5. Manuscript Received: 9 SEP 2011

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Keywords:

  • urologic oncology;
  • disparities;
  • sex;
  • race;
  • insurance;
  • income

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.

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