title: Safety-net burden hospitals and likelihood of curative-intent surgery for non-small cell lung cancer.
abstract: BACKGROUND
  Black patients are less likely to undergo surgery for early-stage non-small cell lung cancer (NSCLC) compared with white patients, and are more likely to undergo resection at low-volume hospitals. However, little is known about the relationship between hospital safety-net burden and the likelihood of curative-intent surgery for black and white patients. This study analyzes whether hospital safety-net burden is associated with curative-intent surgery among adult early-stage NSCLC patients treated at facilities accredited by the American College of Surgeons Commission on Cancer.
  
  
  METHODS
  Adult patients diagnosed with invasive initial primary early-stage (TNM I-II) NSCLC during 2003-2005 were obtained from the National Cancer Data Base. Curative-intent surgery included anatomic resection, wedge resection, and segmentectomy. Hospital safety-net burden was defined as the percent of cancer patients per facility that were Medicaid-insured or uninsured. Generalized estimating equations and linear mixed models were used to control for clustering by facility.
  
  
  RESULTS
  Of 52,853 evaluable patients, those treated at high safety-net burden facilities were significantly less likely (unadjusted p < 0.0001) to undergo curative-intent surgery than patients treated at low safety-net burden facilities. Controlling for patient and other facility characteristics, high safety-net burden remained significantly associated (p < 0.0001) with reduced likelihood of curative-intent surgery overall (odds ratio = 0.69; 95% CI, 0.62-0.77) and in black- and white-only models (odds ratio = 0.59, 95% CI, 0.48-0.73; odds ratio = 0.71; 95% CI, 0.63-0.80, respectively).
  
  
  CONCLUSIONS
  Both black and white adult patients treated for early-stage NSCLC at high safety-net burden facilities are less likely to undergo curative-intent surgery than those treated at low safety-net burden facilities. Innovative solutions are needed to ensure quality cancer care at high safety-net burden facilities.
authors: Health Services Research Department, American Cancer Society, National Home Office, Atlanta, GA, USA.
authors: Katherine S
authors: KS
authors: Virgo
authors: Alex G
authors: AG
authors: Little
authors: Stacey A
authors: SA
authors: Fedewa
authors: Amy Y
authors: AY
authors: Chen
authors: W Dana
authors: WD
authors: Flanders
authors: Elizabeth M
authors: EM
authors: Ward
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian / Q000706:statistics & numerical data; D002289:Carcinoma, Non-Small-Cell Lung / Q000208:ethnology* / Q000473:pathology / Q000601:surgery*; D015986:Confounding Factors, Epidemiologic; D004469:Economics, Hospital / Q000706:statistics & numerical data; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D016015:Logistic Models; D008175:Lung Neoplasms / Q000208:ethnology* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008484:Medicaid; D017057:Medically Uninsured / Q000706:statistics & numerical data; D006278:Medicare; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016017:Odds Ratio; D011013:Pneumonectomy / Q000379:methods* / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data