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.
journal_name
Cancerjournal_title
Cancerauthors
Trinh QD,Sun M,Sammon J,Bianchi M,Sukumar S,Ghani KR,Jeong W,Dabaja A,Shariat SF,Perrotte P,Agarwal PK,Rogers CG,Peabody JO,Menon M,Karakiewicz PIdoi
10.1002/cncr.27440subject
Has Abstractpub_date
2012-09-15 00:00:00pages
4421-6issue
18eissn
0008-543Xissn
1097-0142journal_volume
118pub_type
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