Socioeconomic and racial differences in treatment for breast cancer at a low-volume hospital. Ann Surg Oncol 2011 Oct;18(11):3220-7
Date
08/24/2011Pubmed ID
21861226Pubmed Central ID
PMC3201787DOI
10.1245/s10434-011-2001-zScopus ID
2-s2.0-83055194541 (requires institutional sign-in at Scopus site) 23 CitationsAbstract
PURPOSE: Population-based studies have revealed higher mortality among breast cancer patients treated in low-volume hospitals. Other studies have demonstrated disparities in race and socioeconomic status (SES) in breast cancer survival. The purpose of our study was to determine whether nonwhite or low-SES patients are disproportionately treated in low-volume hospitals.
METHODS: A population-based cohort of 2,777 Medicare breast cancer patients who underwent breast cancer surgery in 2003 participated in a survey study examining breast cancer outcomes. Information was obtained from survey responses, Medicare claims, and state tumor registry data.
RESULTS: On univariate analysis, patients treated at low-volume hospitals were less likely to be white, less likely to live in an urban location, and more likely to have a low SES with less social support and live a greater distance from a high-volume hospital. Education, marital status, total household income, having additional insurance besides Medicare, population density of primary residence, and tangible support were associated with distance to the nearest high-volume hospital. On multivariate analysis, the independent predictors of treatment at a low-volume hospital were being nonwhite (P = 0.003), having a lower household income (P < 0.0001), residence in a rural location (P = 0.01), and living a greater distance from a high-volume hospital (P < 0.0001).
CONCLUSIONS: In this large population-based cohort, women who were poorer, nonwhite, and who lived in a rural location or at a greater distance from a high-volume hospital were more likely to be treated at low-volume hospitals. These differences may partially explain racial and SES disparities in breast cancer outcomes.
Author List
Kong AL, Yen TW, Pezzin LE, Miao H, Sparapani RA, Laud PW, Nattinger ABAuthors
Amanda L. Kong MD, MS Professor in the Surgery department at Medical College of WisconsinPurushottam W. Laud PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Ann B. Nattinger MD, MPH Associate Provost, Professor in the Medicine department at Medical College of Wisconsin
Liliana Pezzin PhD, JD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Rodney Sparapani PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Tina W F Yen MD, MS Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Age FactorsAged
Aged, 80 and over
Breast Neoplasms
Female
Follow-Up Studies
Health Status Disparities
Healthcare Disparities
Hospitals
Humans
Mastectomy
Medicare
Prognosis
Rural Population
Socioeconomic Factors
United States
