title: Endometrial cancer surgery in Arizona: a statewide analysis of access to care.
abstract: OBJECTIVE
  To investigate access to surgical care for endometrial cancer in Arizona.
  
  
  METHODS
  The Arizona HealthQuery (AZHQ) data warehouse with claims information on over 7 million patients in Arizona was searched using the International Classification of Disease (ICD-9) codes and Current Procedural Terminology (CPT) codes for endometrial cancer surgery from 2005 to 2008. Coordinates were gathered for patients and hospital to determine the distance traveled, race, insurance and annual caseload per hospital/surgeon were collected. Distance traveled was local (< 50 miles) or distant (≥ 50 miles) and served as the primary independent variable. Secondary variables included age, race, insurance, surgeon annual volume, and hospital annual volume. Logistic regression for distance traveled was performed for insurance coverage, race, hospital volume, and surgeon volume and expressed as an odds ratio.
  
  
  RESULTS
  There were 1532 endometrial cancer surgeries performed at 67 hospitals by 242 surgeons in 15 counties. Most (61%) were performed by high-volume surgeons. Approximately 1 in 5 (19%) of patients traveled greater than 50 miles. Medicare insured patients were twice (OR=2.07, 95% CI=1.38-3.13) and Medicaid patients were three times (OR=3.41, 95% CI=1.89-6.15) as likely to travel over 50 miles. No significant difference was found between uninsured and privately insured patients (OR=0.87, 95% CI=0.45-1.68). Patients were more likely to travel to a high volume facility (OR 2.39, 95% CI=1.26-4.51). Hispanics (OR=2.72, 95% CI=1.72-4.32) and Native Americans (OR=8.60, 95% CI=3.43-21.52) were more likely to travel compared to Caucasians.
  
  
  CONCLUSIONS
  In Arizona significantly different patterns of care are seen for endometrial cancer surgery based upon insurance coverage, race, surgeon and hospital. Patients travel farther to a high-volume hospital and high-volume surgeon. Hispanics or Native Americans travel farther for care when compared with Caucasians. Patients on government funded insurance plans travel farther for care than patients covered by private insurance or those lacking insurance.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Creighton University School of Medicine at St. Joseph's Hospital and Medical Center, a Member of Catholic Healthcare West, Phoenix, AZ, USA. ivor.benjamin@chw.edu
authors.forename: Ivor
authors.initials: I
authors.lastname: Benjamin
authors.forename: Heather
authors.initials: H
authors.lastname: Dalton
authors.forename: Yue
authors.initials: Y
authors.lastname: Qiu
authors.forename: Leslie
authors.initials: L
authors.lastname: Cayco
authors.forename: William G
authors.initials: WG
authors.lastname: Johnson
authors.forename: James
authors.initials: J
authors.lastname: Balducci
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001130:Arizona / Q000453:epidemiology; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D016889:Endometrial Neoplasms / Q000453:epidemiology / Q000208:ethnology / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data; D006176:Gynecology; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008495:Medical Oncology; D008875:Middle Aged; D000078329:Workforce; D055815:Young Adult