title: Racial disparities in cancer care in the Veterans Affairs health care system and the role of site of care.
abstract: OBJECTIVE
  We assessed cancer care disparities within the Veterans Affairs (VA) health care system and whether between-hospital differences explained disparities.
  
  
  METHODS
  We linked VA cancer registry data with VA and Medicare administrative data and examined 20 cancer-related quality measures among Black and White veterans diagnosed with colorectal (n = 12,897), lung (n = 25,608), or prostate (n = 38,202) cancer from 2001 to 2004. We used logistic regression to assess racial disparities for each measure and hospital fixed-effects models to determine whether disparities were attributable to between- or within-hospital differences.
  
  
  RESULTS
  Compared with Whites, Blacks had lower rates of early-stage colon cancer diagnosis (adjusted odds ratio [AOR] = 0.80; 95% confidence interval [CI] = 0.72, 0.90), curative surgery for stage I, II, or III rectal cancer (AOR = 0.57; 95% CI = 0.41, 0.78), 3-year survival for colon cancer (AOR = 0.75; 95% CI = 0.62, 0.89) and rectal cancer (AOR = 0.61; 95% CI = 0.42, 0.87), curative surgery for early-stage lung cancer (AOR = 0.50; 95% CI = 0.41, 0.60), 3-dimensional conformal or intensity-modulated radiation (3-D CRT/IMRT; AOR = 0.53; 95% CI = 0.47, 0.59), and potent antiemetics for highly emetogenic chemotherapy (AOR = 0.87; 95% CI = 0.78, 0.98). Adjustment for hospital fixed-effects minimally influenced racial gaps except for 3-D CRT/IMRT (AOR = 0.75; 95% CI = 0.65, 0.87) and potent antiemetics (AOR = 0.95; 95% CI = 0.82, 1.10).
  
  
  CONCLUSIONS
  Disparities in VA cancer care were observed for 7 of 20 measures and were primarily attributable to within-hospital differences.
authors.affiliation: Cleo A. Samuel, Mary Beth Landrum, Barbara J. McNeil, and Nancy L. Keating are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Samuel R. Bozeman is with Abt Associates, Cambridge, MA. Christina D. Williams is with the Division of Hematology-Oncology, Durham Veterans Affairs Medical Center, Durham, NC.
authors.forename: Cleo A
authors.initials: CA
authors.lastname: Samuel
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Landrum
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: McNeil
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Bozeman
authors.forename: Christina D
authors.initials: CD
authors.lastname: Williams
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
mesh_terms: D001741:Black or African American; D000368:Aged; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy; D018426:SEER Program; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D058014:Veterans Health; D044465:White People
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