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Influence of Place of Residence in Access to Specialized Cancer Care for African Americans

Authors

  • Tracy Onega PhD,

    1. The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
    2. Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire
    3. Norris Cotton Cancer Center, Lebanon, New Hampshire
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  • Eric J. Duell PhD,

    1. The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
    2. Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire
    3. Norris Cotton Cancer Center, Lebanon, New Hampshire
    4. Catalan Institute of Oncology, Barcelona, Spain
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  • Xun Shi PhD,

    1. Department of Geography, Dartmouth College, Hanover, New Hampshire
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  • Eugene Demidenko PhD,

    1. Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire
    2. Norris Cotton Cancer Center, Lebanon, New Hampshire
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  • David Goodman MD, MS

    1. The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
    2. Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire
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  • This work was supported in part by National Institutes of Health Grant Number 1P20RR018787; and by the Agency for Healthcare Research and Quality under Ruth L. Kirschstein National Research Service Award no. T32HS000070. This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, National Cancer Institute; the Office of Research, Development and Information, Centers for Medicare & Medicaid Services; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.They would like to thank Dan Gottlieb, MS, for his invaluable assistance with creation of the analytic dataset and keen advice. For further information, contact: Tracy Onega, PhD, Department of Community and Family Medicine, Dartmouth Medical School, HB 7927, Rubin Building, 8th Floor, One Medical Center Drive, Lebanon, NH 03756; e-mail Tracy.L.Onega@dartmouth.edu.

Abstract

Context: Disparities in cancer care for rural residents and for African Americans have been documented, but the interaction of these factors is not well understood.

Purpose: The authors examined the simultaneous influence of race and place of residence on access to and utilization of specialized cancer care in the United States.

Methods: Access to specialized cancer care was measured using: (1) travel time to National Cancer Institute (NCI) Cancer Centers, academic medical centers, and any oncologist for the entire continental US population, and (2) per capita availability of oncologists for the entire United States. Utilization was measured as attendance at NCI Cancer Centers, specialized hospitals, and other hospitals in the Surveillance, Epidemiology, and End Results (SEER) program Medicare population from 1998-2004.

Findings: In urban settings, travel times were shorter for African Americans compared with Caucasians for all three cancer care settings, but they were longer for rural African Americans traveling to NCI Cancer Centers. Per capita oncologist availability was not significantly different by race or place of residence. Urban African American patients were almost 70% more likely to attend an NCI Cancer Center than urban Caucasian patients (OR = 1.66; 95% CI 1.51-1.83), whereas rural African American patients were 58% less likely to attend an NCI Cancer Center than rural Caucasian patients (OR = 0.42; 95% CI 0.26-0.66).

Conclusions: Urban African Americans have similar or better access to specialized cancer care than urban Caucasians, but rural African Americans have relatively poor access and lower utilization compared with all other groups.

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