Ethnic/racial disparities in hospital procedure volume for lung resection for lung cancer.
BACKGROUND
Ethnic/racial minorities experience poorer outcomes from lung cancer than non-Hispanic whites. Higher hospital procedure volume is associated with better survival from lung resection for lung cancer.


OBJECTIVE
We examined whether (1) ethnic/racial minorities are more likely to obtain lung resections at lower volume hospitals, (2) ethnicity/race is associated with inpatient mortality, (3) hospital volume mediates this association, and (4) hospital selection is mediated by racial/ethnic segregation, differences in insurance coverage, or limited hospital choice.


METHODS
Six years of data from the Nationwide Inpatient Sample (NIS 1998-2003, unweighted n = 50,245, weighted n = 129,506) were used in multivariate models controlling for sociodemographic factors, case complexity, and hospital characteristics. Additional analyses were conducted using the Area Resource File, which provided data on ethnic density and number of surgical hospitals in the hospital region.


RESULTS
Blacks/African Americans (odds ratio [OR] = 0.45; 0.34-0.58) and Latinos (OR = 0.44; 0.32-0.63) had lower odds of obtaining lung resection at a high-volume hospital than non-Hispanic whites. Blacks/African Americans (OR = 1.30; 1.01-1.67), Latinos (OR = 1.41; 1.02-1.94), and other racial/ethnic minorities (OR = 1.46; 1.04-2.06) also had higher odds of dying in hospital, but this association was statistically nonsignificant after controlling for hospital volume. Hospital location was not associated with lung resection procedure volume, nor did location mediate the association between ethnicity/race and hospital volume.


CONCLUSIONS
Ethnic/racial minorities are obtaining lung resection in lower volume hospitals and are more likely to die in hospital. Hospital volume is associated with higher mortality, but health insurance, segregation, and number of surgical hospitals within a county do not account for observed disparities.
Neighbors
Charles J
CJ
National Center on Addiction and Substance Abuse at Columbia University, 633 Third Avenue, New York, NY 10017, USA. cneighbors@casacolumbia.edu
Rogers
Michelle L
ML
Shenassa
Edmond D
ED
Sciamanna
Christopher N
CN
Clark
Melissa A
MA
Novak
Scott P
SP
D001741:Black or African American; D000368:Aged; D003256:Community Participation; D005260:Female; D006297:Health Services Accessibility; D006630:Hispanic or Latino; D006739:Hospital Administration; D006742:Hospital Bed Capacity; D017052:Hospital Mortality; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008175:Lung Neoplasms / Q000208:ethnology* / Q000601:surgery*; D008297:Male; D011787:Quality of Health Care; D012424:Rural Population; D014505:Urban Population; D044465:White People