title: Influence of socioeconomic status and hospital type on disparities of lymph node evaluation in colon cancer patients.
abstract: BACKGROUND
  A minimum of 12 dissected lymph nodes (LNs) has been recommended as a consensus guideline for resections in colon cancer patients. This study assessed the influence of both socioeconomic status (SES) and hospital type on compliance with this colon LN dissection guideline and examined the time trend for ≥12 LNs dissected.
  
  
  METHODS
  Stage I to III incident colon cancer cases diagnosed from 1996 to 2007 were obtained from the Louisiana Tumor Registry. A composite census tract-level SES score was created to serve as a surrogate for individual-level SES. Hospitals performing colon resections were categorized into 5 groups according to the Commission on Cancer Accreditation Program. Multiple logistic regression analyses were used.
  
  
  RESULTS
  Of 10,460 colon cancer cases diagnosed during the study period, 43.9% had ≥12 LNs dissected. Patients residing in less affluent SES areas were less likely to receive a dissection of ≥12 nodes than those residing in more affluent areas. SES was no longer significant after adjusting for race, sex, age, stage, grade, anatomic subsite, diagnosis year, and hospital type. In contrast, hospital type was significantly associated with the number of LNs dissected, even after adjusting for other factors. Patients diagnosed from 2002 to 2007 were twice as likely (95% confidence interval, 1.84-2.17) to have ≥12 LNs dissected than those diagnosed from 1996 to 2001 after adjustment.
  
  
  CONCLUSIONS
  In Louisiana, hospital type is an independent significant predictor of adequate LN evaluation for colon cancer. Training and education are needed to reduce this disparity in the facilities with consistently lower LN yield in their dissections.
authors: Louisiana Tumor Registry and Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA. mhsieh@lsuhsc.edu
authors: Mei-Chin
authors: MC
authors: Hsieh
authors: Cruz
authors: C
authors: Velasco
authors: Xiao-Cheng
authors: XC
authors: Wu
authors: Lisa A
authors: LA
authors: Pareti
authors: Patricia A
authors: PA
authors: Andrews
authors: Vivien W
authors: VW
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D054625:Healthcare Disparities; D006761:Hospitals; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012923:Social Class