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Hospital Accreditation and Geographic Disparities in Timely Cancer Care
Journal article   Open access   Peer reviewed

Hospital Accreditation and Geographic Disparities in Timely Cancer Care

Jason T Semprini, Joshua W Devine, Ingrid M Lizarraga and Mary E Charlton
Health services research, Vol.61(2), e14655
04/2026
DOI: 10.1111/1475-6773.14655
PMCID: PMC12968059
PMID: 40476571
url
https://pmc.ncbi.nlm.nih.gov/articles/PMC12968059/View
Open Access

Abstract

To evaluate whether the association between receiving care at an accredited hospital and timely treatment initiation varies by county income level. This cross-sectional study compared days from diagnosis to treatment initiation among patients receiving care at CoC-accredited hospitals with patients receiving care at non-accredited hospitals. We estimated distributional effects with a quantile regression model. We stratified patients into low (median household-income < 80k) and high-income (median household-income ≥ 80k) counties. We analyzed population-based Surveillance, Epidemiological, and End Results case data (2018-2021). We excluded cancer cases that did not receive treatment. All analyses were adjusted for tumor and patient characteristics, treatment received, and geographic factors. Among 2,107,188 patients receiving cancer treatment, 73.65% received care at an accredited hospital. Median time-to-treatment was 27 days (interquartile range = 1-52). Care at an accredited hospital was associated with longer median time-to-treatment (+2.6 days) in low-income counties but not high-income counties. Similarly, care at an accredited hospital was associated with widening the time-to-treatment interquartile range (+1.8 days) in low-income but not high-income counties. The magnitude of these associations was highest in patients aged 65+, unmarried, diagnosed at an early stage, and in less common cancers. Only among patients diagnosed with distant-stage cancer was accreditation associated with reduced median time-to-treatment in both low and high-income counties. Treatment at an accredited hospital appeared to increase time-to-treatment differences between high-and low-income counties and low-income counties. This heterogeneity may reflect access challenges facing low-income cancer patients. Health systems seeking to provide high quality, timely care must overcome these access challenges as they navigate patients through the cancer care continuum. While a 2.6-day delay in treatment may not impact outcomes, future research should understand why patients from lower-resource communities wait longer than patients in affluent communities.

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