title: Socioeconomic and racial differences in treatment for breast cancer at a low-volume hospital.
abstract: OBJECTIVE
  Population-based studies have revealed higher mortality among breast cancer patients treated in low-volume hospitals. Other studies have demonstrated disparities in race and socioeconomic status (SES) in breast cancer survival. The purpose of our study was to determine whether nonwhite or low-SES patients are disproportionately treated in low-volume hospitals.
  
  
  METHODS
  A population-based cohort of 2,777 Medicare breast cancer patients who underwent breast cancer surgery in 2003 participated in a survey study examining breast cancer outcomes. Information was obtained from survey responses, Medicare claims, and state tumor registry data.
  
  
  RESULTS
  On univariate analysis, patients treated at low-volume hospitals were less likely to be white, less likely to live in an urban location, and more likely to have a low SES with less social support and live a greater distance from a high-volume hospital. Education, marital status, total household income, having additional insurance besides Medicare, population density of primary residence, and tangible support were associated with distance to the nearest high-volume hospital. On multivariate analysis, the independent predictors of treatment at a low-volume hospital were being nonwhite (P = 0.003), having a lower household income (P < 0.0001), residence in a rural location (P = 0.01), and living a greater distance from a high-volume hospital (P < 0.0001).
  
  
  CONCLUSIONS
  In this large population-based cohort, women who were poorer, nonwhite, and who lived in a rural location or at a greater distance from a high-volume hospital were more likely to be treated at low-volume hospitals. These differences may partially explain racial and SES disparities in breast cancer outcomes.
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. akong@mcw.edu
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Kong
authors.forename: Tina W F
authors.initials: TW
authors.lastname: Yen
authors.forename: Liliana E
authors.initials: LE
authors.lastname: Pezzin
authors.forename: Haiyan
authors.initials: H
authors.lastname: Miao
authors.forename: Rodney A
authors.initials: RA
authors.lastname: Sparapani
authors.forename: Purushottam W
authors.initials: PW
authors.lastname: Laud
authors.forename: Ann B
authors.initials: AB
authors.lastname: Nattinger
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000191:economics* / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008408:Mastectomy; D006278:Medicare; D011379:Prognosis; D012424:Rural Population; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*