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Disparities in access to care at high-volume institutions for uro-oncologic procedures
Article first published online: 1 FEB 2012
Copyright © 2012 American Cancer Society
Volume 118, Issue 18, pages 4421–4426, 15 September 2012
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
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- Issue published online: 5 SEP 2012
- Article first published online: 1 FEB 2012
- Manuscript Accepted: 13 DEC 2011
- Manuscript Revised: 2 NOV 2011
- Manuscript Received: 9 SEP 2011
- urologic oncology;
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.
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.
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).
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.