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
AU - Brem, Henry
AU - Chang, David C.
AU - Quinones-Hinojosa, Alfredo
N1 - Copyright:
Copyright 2010 Elsevier B.V., All rights reserved.
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.
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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 -