title: Hospital factors and racial disparities in mortality after surgery for breast and colon cancer.
abstract: OBJECTIVE
  Black patients have worse prognoses than whites with breast or colorectal cancer. Mechanisms underlying such disparities have not been fully explored. We examined the role of hospital factors in racial differences in late mortality after surgery for breast or colon cancer.
  
  
  METHODS
  Patients undergoing surgery after new diagnosis of breast or colon cancer were identified using the Surveillance Epidemiology and End Results-Medicare linked database (1995 to 2005). The main outcome measure was mortality at 5 years. Proportional hazards models were used to assess relationships between race and late mortality, accounting for patient factors, socioeconomic measures, and hospital factors. Fixed and random effects models were used to account for quality differences across hospitals.
  
  
  RESULTS
  Black patients, compared with white patients, had lower 5-year overall survival rates after surgery for breast (62.1% v 70.4%, respectively; P < .001) and colon cancer (41.3% v 45.4%, respectively; P < .001). After controlling for age, comorbidity, and stage, black race remained an independent predictor of mortality for breast (adjusted hazard ratio [HR] = 1.25; 95% CI, 1.16 to 1.34) and colon cancer (adjusted HR = 1.13; 95% CI, 1.07 to 1.19). After risk adjustment, hospital factors explained 36% and 54% of the excess mortality for black patients with breast cancer and colon cancer, respectively. Hospitals with large minority populations had higher late mortality rates independent of race.
  
  
  CONCLUSIONS
  Hospital factors, including quality, are important mediators of the association between race and mortality for breast and colon cancer. Hospital-level quality improvement should be a major component of efforts to reduce disparities in cancer outcomes.
authors.affiliation: Michigan Surgical Collaborative for Outcomes Research and Evaluation, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Tara M
authors.initials: TM
authors.lastname: Breslin
authors.forename: Arden M
authors.initials: AM
authors.lastname: Morris
authors.forename: Niya
authors.initials: N
authors.lastname: Gu
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Wong
authors.forename: Emily V
authors.initials: EV
authors.lastname: Finlayson
authors.forename: Mousumi
authors.initials: M
authors.lastname: Banerjee
authors.forename: John D
authors.initials: JD
authors.lastname: Birkmeyer
mesh_terms: D000368:Aged; D044383:Black People; D001943:Breast Neoplasms / Q000208:ethnology* / Q000401:mortality* / Q000601:surgery; D003110:Colonic Neoplasms / Q000208:ethnology* / Q000401:mortality* / Q000601:surgery; D005260:Female; D054625:Healthcare Disparities; D006761:Hospitals; D006801:Humans; D011787:Quality of Health Care; D018426:SEER Program; D044465:White People