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Safety-net burden hospitals and likelihood of curative-intent surgery for non-small cell lung cancer.
- Source :
-
Journal of the American College of Surgeons [J Am Coll Surg] 2011 Nov; Vol. 213 (5), pp. 633-43. Date of Electronic Publication: 2011 Sep 08. - Publication Year :
- 2011
-
Abstract
- Background: Black patients are less likely to undergo surgery for early-stage non-small cell lung cancer (NSCLC) compared with white patients, and are more likely to undergo resection at low-volume hospitals. However, little is known about the relationship between hospital safety-net burden and the likelihood of curative-intent surgery for black and white patients. This study analyzes whether hospital safety-net burden is associated with curative-intent surgery among adult early-stage NSCLC patients treated at facilities accredited by the American College of Surgeons Commission on Cancer.<br />Study Design: Adult patients diagnosed with invasive initial primary early-stage (TNM I-II) NSCLC during 2003-2005 were obtained from the National Cancer Data Base. Curative-intent surgery included anatomic resection, wedge resection, and segmentectomy. Hospital safety-net burden was defined as the percent of cancer patients per facility that were Medicaid-insured or uninsured. Generalized estimating equations and linear mixed models were used to control for clustering by facility.<br />Results: Of 52,853 evaluable patients, those treated at high safety-net burden facilities were significantly less likely (unadjusted p < 0.0001) to undergo curative-intent surgery than patients treated at low safety-net burden facilities. Controlling for patient and other facility characteristics, high safety-net burden remained significantly associated (p < 0.0001) with reduced likelihood of curative-intent surgery overall (odds ratio = 0.69; 95% CI, 0.62-0.77) and in black- and white-only models (odds ratio = 0.59, 95% CI, 0.48-0.73; odds ratio = 0.71; 95% CI, 0.63-0.80, respectively).<br />Conclusions: Both black and white adult patients treated for early-stage NSCLC at high safety-net burden facilities are less likely to undergo curative-intent surgery than those treated at low safety-net burden facilities. Innovative solutions are needed to ensure quality cancer care at high safety-net burden facilities.<br /> (Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Black or African American statistics & numerical data
Aged
Aged, 80 and over
Asian statistics & numerical data
Carcinoma, Non-Small-Cell Lung pathology
Confounding Factors, Epidemiologic
Economics, Hospital statistics & numerical data
Female
Hispanic or Latino statistics & numerical data
Humans
Logistic Models
Lung Neoplasms pathology
Male
Medicaid
Medically Uninsured statistics & numerical data
Medicare
Middle Aged
Multivariate Analysis
Neoplasm Staging
Odds Ratio
United States epidemiology
White People statistics & numerical data
Carcinoma, Non-Small-Cell Lung ethnology
Carcinoma, Non-Small-Cell Lung surgery
Hospitals statistics & numerical data
Insurance, Health statistics & numerical data
Lung Neoplasms ethnology
Lung Neoplasms surgery
Pneumonectomy methods
Pneumonectomy statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1190
- Volume :
- 213
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Journal of the American College of Surgeons
- Publication Type :
- Academic Journal
- Accession number :
- 21907598
- Full Text :
- https://doi.org/10.1016/j.jamcollsurg.2011.07.014