Disparities in access to neuro-oncologic care in the United States

Debraj Mukherjee, Hasan A. Zaidi, Thomas Kosztowski, Kaisorn L. Chaichana, Henry Brem, David C. Chang, Alfredo Quinones-Hinojosa

Research output: Contribution to journalArticle

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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 languageEnglish (US)
Pages (from-to)247-253
Number of pages7
JournalArchives of Surgery
Volume145
Issue number3
DOIs
StatePublished - Mar 2010
Externally publishedYes

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High-Volume Hospitals
Odds Ratio
Craniotomy
Hispanic Americans
Poverty
African Americans
Comorbidity
Low-Volume Hospitals
Biopsy
Insurance Coverage
Inpatients
Neoplasms
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Surgery

Cite this

Mukherjee, D., Zaidi, H. A., Kosztowski, T., Chaichana, K. L., Brem, H., Chang, D. C., & Quinones-Hinojosa, A. (2010). Disparities in access to neuro-oncologic care in the United States. Archives of Surgery, 145(3), 247-253. https://doi.org/10.1001/archsurg.2009.288

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.; Quinones-Hinojosa, Alfredo.

In: Archives of Surgery, Vol. 145, No. 3, 03.2010, p. 247-253.

Research output: Contribution to journalArticle

Mukherjee, D, Zaidi, HA, Kosztowski, T, Chaichana, KL, Brem, H, Chang, DC & Quinones-Hinojosa, A 2010, 'Disparities in access to neuro-oncologic care in the United States', Archives of Surgery, vol. 145, no. 3, pp. 247-253. https://doi.org/10.1001/archsurg.2009.288
Mukherjee D, Zaidi HA, Kosztowski T, Chaichana KL, Brem H, Chang DC et al. Disparities in access to neuro-oncologic care in the United States. Archives of Surgery. 2010 Mar;145(3):247-253. https://doi.org/10.1001/archsurg.2009.288
Mukherjee, Debraj ; Zaidi, Hasan A. ; Kosztowski, Thomas ; Chaichana, Kaisorn L. ; Brem, Henry ; Chang, David C. ; Quinones-Hinojosa, Alfredo. / Disparities in access to neuro-oncologic care in the United States. In: Archives of Surgery. 2010 ; Vol. 145, No. 3. pp. 247-253.
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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.",
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