Disparities in access to pediatric neurooncological surgery in the United States.
OBJECTIVE
The objective of this study was to investigate whether disparities in access to high-volume centers for neurooncological care existed in the United States in 1988-2005.


METHODS
A retrospective analysis of the Nationwide Inpatient Sample (1988-2005) was performed, with additional factors incorporated from the Area Resource File (2006). International Classification of Diseases, Ninth Revision, diagnosis/procedure coding was used to identify patients. High-volume centers were defined as those with > or =50 neurosurgical cases per year. Patients >18 years of age were excluded. Covariates included age, gender, race, Charlson Index score, insurance, and county-level characteristics (including median home value, proportion of foreign born residents, and county neurosurgeon density). Multivariate analysis was performed by using multiple logistic regression models. P values of <.05 were considered statistically significant.


RESULTS
A total of 4421 patients were identified; 1651 (37.34%) were admitted to high-volume centers. Overall access to high-volume centers improved slightly over the 18-year period (odds ratio [OR]: 1.04). Factors associated with greater access to high-volume centers included greater county neurosurgeon density (OR: 1.72) and greater county home value (OR: 1.66). Factors associated with worse access included Hispanic ethnicity (OR: 0.68) and each 1% increase in foreign residents per county (OR: 0.59). All reported P values were <.05.


CONCLUSIONS
This study demonstrates that racial and socioeconomic disparities in access to high-volume neurooncological care exist for the pediatric population. We also identify numerous prehospital factors that potentially contribute to persistent disparities and may be amenable to change through national health policy interventions.
Mukherjee
Debraj
D
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Kosztowski
Thomas
T
Zaidi
Hasan A
HA
Jallo
George
G
Carson
Benjamin S
BS
Chang
David C
DC
Quiñones-Hinojosa
Alfredo
A
D000046:Academic Medical Centers; D000293:Adolescent; D001932:Brain Neoplasms / Q000175:diagnosis / Q000208:ethnology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures / Q000191:economics / Q000706:statistics & numerical data*; D016017:Odds Ratio; D011336:Probability; D011787:Quality of Health Care; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States