Journal article
Racial Disparity in Utilization of High-Volume Hospitals for Surgical Treatment of Esophageal Cancer
The Annals of thoracic surgery, Vol.106(2), pp.346-353
08/2018
DOI: 10.1016/j.athoracsur.2018.03.042
PMID: 29684373
Abstract
Utilization of high-volume hospitals (HVH) for esophagectomy has been associated with improved perioperative outcomes and reduced mortality. We aimed to test the hypothesis that black-white racial disparities exist in HVH utilization and identify predictors of in-hospital surgical outcomes of esophageal cancer while adjusting for HVH utilization patterns.
We queried the New York Statewide Planning and Research Cooperative System database (1995 to 2012) for esophageal cancer patients who underwent surgical resection exclusively. Only records for patients with self-reported white or black race and a valid New York State ZIP code were included (n = 2,895). Analysis was performed to identify factors associated with HVH hospital (≥20 esophagectomies/year) utilization and determine predictors of complications and in-hospital mortality.
Black patients (361 [12.5%]) were significantly different (p < 0.001) than their white counterparts in the proportion of women, Medicaid, income distribution, and privately insured individuals. Although 55% patients overall utilized an HVH, blacks were significantly less likely to utilize an HVH than whites (odds ratio [OR], 0.18; 95% confidence interval [CI], 0.14 to 0.24), even though 74.5% resided within 8.9 miles of one. Operations performed at HVHs were associated with lower in-hospital mortality (OR, 0.48; 95% CI, 0.35 to 0.65); however, mortality remained higher for blacks (OR, 2.04; 95% CI, 1.65 to 3.30; propensity matched OR, 2.45; 95% CI, 1.5 to 4.03).
Black patients were less likely to undergo esophagectomy at an HVH and experienced higher mortality. Efforts should be made to understand factors influencing patients' decision process and improve referral practices to ensure optimal care is provided across all segments of the population, irrespective of race, insurance, or income status.
Details
- Title: Subtitle
- Racial Disparity in Utilization of High-Volume Hospitals for Surgical Treatment of Esophageal Cancer
- Creators
- Sadiq S Rehmani - Icahn School of Medicine at Mount SinaiBian Liu - Icahn School of Medicine at Mount SinaiAdnan M Al-Ayoubi - Department of Surgery, Carver College of Medicine, University of Iowa, Iowa City, IowaWissam Raad - Icahn School of Medicine at Mount SinaiRaja M Flores - Icahn School of Medicine at Mount SinaiFaiz Bhora - Icahn School of Medicine at Mount SinaiEmanuela Taioli - Icahn School of Medicine at Mount Sinai
- Resource Type
- Journal article
- Publication Details
- The Annals of thoracic surgery, Vol.106(2), pp.346-353
- DOI
- 10.1016/j.athoracsur.2018.03.042
- PMID
- 29684373
- ISSN
- 0003-4975
- eISSN
- 1552-6259
- Language
- English
- Date published
- 08/2018
- Academic Unit
- Cardiothoracic Surgery
- Record Identifier
- 9984701732902771
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