Abstract
Hypothesis: Race/ethnicity and social status influence admission to high-volume hospitals among patients who undergo craniotomy for tumor biopsy or resection. Design: Retrospective analysis of the Nationwide Inpatient Sample (1988-2005), with additional factors from the Area Resource File. Setting: A 20% representative sample of all hospitals in 37 US states. Patients: A total of 76 436 patients 18 years or older who were admitted and underwent craniotomy for tumor biopsy or resection. Main Outcome Measures: Odds ratios (ORs) for the association of age, sex, race/ethnicity, insurance status, Charlson Comorbidity Index, and county-level characteristics with admission to high-volume hospitals (>50 craniotomies per year) or low-volume hospitals. Results: A total of 25 481 patients (33.3%) were admitted to high-volume hospitals. Overall access to high-volume hospitals improved over time. However, racial/ethnic disparities in access to high-volume hospitals dramatically worsened for Hispanics (OR, 0.49) and African Americans (OR, 0.62) in recent years. Factors associated with better access to high-volume hospitals included years since 1988 (OR, 1.11), greater countywide neurosurgeon density (OR, 1.66), and higher countywide median household income (OR, 1.71). Factors associated with worse access to high-volume hospitals included older age (OR, 0.34 per year increase), increased countywide poverty rate (OR, 0.57), Hispanic race/ethnicity (OR, 0.68), and higher Charlson Comorbidity Index (OR, 0.96 per point increase). Conclusions: African Americans and Hispanics have disproportionately worse access to high-quality neuro-oncologic care over time compared with whites. Higher countywide median household income and decreased countywide poverty rate were associated with better access to high-volume hospitals, implicating socioeconomic factors in predicting admission to high-quality centers.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 247-253 |
| Number of pages | 7 |
| Journal | Archives of Surgery |
| Volume | 145 |
| Issue number | 3 |
| DOIs | |
| State | Published - Mar 2010 |
Fingerprint
ASJC Scopus subject areas
- Surgery
Cite this
Disparities in access to neuro-oncologic care in the United States. / Mukherjee, Debraj; Zaidi, Hasan A.; Kosztowski, Thomas; Chaichana, Kaisorn L.; Brem, Henry; Chang, David C.; Quiñones-Hinojosa, Alfredo.
In: Archives of Surgery, Vol. 145, No. 3, 03.2010, p. 247-253.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Disparities in access to neuro-oncologic care in the United States
AU - Mukherjee, Debraj
AU - Zaidi, Hasan A.
AU - Kosztowski, Thomas
AU - Chaichana, Kaisorn L.
AU - Brem, Henry
AU - Chang, David C.
AU - Quiñones-Hinojosa, Alfredo
PY - 2010/3
Y1 - 2010/3
N2 - Hypothesis: Race/ethnicity and social status influence admission to high-volume hospitals among patients who undergo craniotomy for tumor biopsy or resection. Design: Retrospective analysis of the Nationwide Inpatient Sample (1988-2005), with additional factors from the Area Resource File. Setting: A 20% representative sample of all hospitals in 37 US states. Patients: A total of 76 436 patients 18 years or older who were admitted and underwent craniotomy for tumor biopsy or resection. Main Outcome Measures: Odds ratios (ORs) for the association of age, sex, race/ethnicity, insurance status, Charlson Comorbidity Index, and county-level characteristics with admission to high-volume hospitals (>50 craniotomies per year) or low-volume hospitals. Results: A total of 25 481 patients (33.3%) were admitted to high-volume hospitals. Overall access to high-volume hospitals improved over time. However, racial/ethnic disparities in access to high-volume hospitals dramatically worsened for Hispanics (OR, 0.49) and African Americans (OR, 0.62) in recent years. Factors associated with better access to high-volume hospitals included years since 1988 (OR, 1.11), greater countywide neurosurgeon density (OR, 1.66), and higher countywide median household income (OR, 1.71). Factors associated with worse access to high-volume hospitals included older age (OR, 0.34 per year increase), increased countywide poverty rate (OR, 0.57), Hispanic race/ethnicity (OR, 0.68), and higher Charlson Comorbidity Index (OR, 0.96 per point increase). Conclusions: African Americans and Hispanics have disproportionately worse access to high-quality neuro-oncologic care over time compared with whites. Higher countywide median household income and decreased countywide poverty rate were associated with better access to high-volume hospitals, implicating socioeconomic factors in predicting admission to high-quality centers.
AB - Hypothesis: Race/ethnicity and social status influence admission to high-volume hospitals among patients who undergo craniotomy for tumor biopsy or resection. Design: Retrospective analysis of the Nationwide Inpatient Sample (1988-2005), with additional factors from the Area Resource File. Setting: A 20% representative sample of all hospitals in 37 US states. Patients: A total of 76 436 patients 18 years or older who were admitted and underwent craniotomy for tumor biopsy or resection. Main Outcome Measures: Odds ratios (ORs) for the association of age, sex, race/ethnicity, insurance status, Charlson Comorbidity Index, and county-level characteristics with admission to high-volume hospitals (>50 craniotomies per year) or low-volume hospitals. Results: A total of 25 481 patients (33.3%) were admitted to high-volume hospitals. Overall access to high-volume hospitals improved over time. However, racial/ethnic disparities in access to high-volume hospitals dramatically worsened for Hispanics (OR, 0.49) and African Americans (OR, 0.62) in recent years. Factors associated with better access to high-volume hospitals included years since 1988 (OR, 1.11), greater countywide neurosurgeon density (OR, 1.66), and higher countywide median household income (OR, 1.71). Factors associated with worse access to high-volume hospitals included older age (OR, 0.34 per year increase), increased countywide poverty rate (OR, 0.57), Hispanic race/ethnicity (OR, 0.68), and higher Charlson Comorbidity Index (OR, 0.96 per point increase). Conclusions: African Americans and Hispanics have disproportionately worse access to high-quality neuro-oncologic care over time compared with whites. Higher countywide median household income and decreased countywide poverty rate were associated with better access to high-volume hospitals, implicating socioeconomic factors in predicting admission to high-quality centers.
UR - http://www.scopus.com/inward/record.url?scp=77951073861&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77951073861&partnerID=8YFLogxK
U2 - 10.1001/archsurg.2009.288
DO - 10.1001/archsurg.2009.288
M3 - Article
C2 - 20231625
AN - SCOPUS:77951073861
VL - 145
SP - 247
EP - 253
JO - JAMA Surgery
JF - JAMA Surgery
SN - 2168-6254
IS - 3
ER -