Disparities in access to care at high-volume institutions for uro-oncologic procedures.
BACKGROUND
Socioeconomic status represents an established barrier to health care access. Age, sex, and race may also play a role. The authors examined whether these affect the access to high-volume hospitals for uro-oncologic procedures in the United States.


METHODS
Within the Nationwide Inpatient Sample (NIS), the authors focused on radical prostatectomy (RP), radical cystectomy, and nephrectomy (Nx) performed within the 5 most contemporary years (2003-2007). Logistic regression models were used to estimate the impact of the primary predictors on the likelihood of receiving care at a high-volume hospital.


RESULTS
Between 2003 and 2007, 62,165 RP, 6557 radical cystectomy, and 28,062 Nx cases were recorded within the NIS. Patient age (P = .001), year of surgery (P = .001), Charlson Comorbidity Index (P ≤ .025), median Zip Code income (highest vs lowest quartile, P = .001), and insurance status (private vs Medicare, P = .008) were independent predictors of being treated at high-volume institutions. Moreover, black race was an independent predictor of decreased utilization of high-volume institutions for radical cystectomy (P = .012), and female sex was an independent predictor of decreased utilization of high-volume institutions for Nx (P = .016).


CONCLUSIONS
On average, old, sick, poor, and Medicare patients were less likely to be treated at high-volume hospitals for uro-oncologic surgery. Similarly, black patients were less likely to have a radical cystectomy at a high-volume hospital, and female patients were less likely to have an Nx at a high-volume hospital. Selective referral of individuals who are less likely to receive care at such institutions may represent a health care priority intended to optimize outcomes across all population strata.
Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA. trinh.qd@gmail.com
Quoc-Dien
QD
Trinh
Maxine
M
Sun
Jesse
J
Sammon
Marco
M
Bianchi
Shyam
S
Sukumar
Khurshid R
KR
Ghani
Wooju
W
Jeong
Ali
A
Dabaja
Shahrokh F
SF
Shariat
Paul
P
Perrotte
Piyush K
PK
Agarwal
Craig G
CG
Rogers
James O
JO
Peabody
Mani
M
Menon
Pierre I
PI
Karakiewicz
D015653:Cystectomy; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006761:Hospitals; D061847:Hospitals, High-Volume; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D006278:Medicare; D009392:Nephrectomy; D011468:Prostatectomy; D044469:Racial Groups; D014481:United States; D014571:Urologic Neoplasms / Q000601:surgery*; D013520:Urologic Surgical Procedures