title: The Impact of Regionalization of Cystectomy on Racial Disparities in Bladder Cancer Care.
abstract: OBJECTIVE
  Regionalization of surgical care has improved the quality of care for patients with bladder cancer. We explored whether regionalization has benefited white and black patients equally.
  
  
  METHODS
  We used a New York State inpatient database to identify all patients who underwent cystectomy for bladder cancer from 1997 to 2011. Hospital volume was classified in quintiles based on the number of cystectomies performed in the first 5 years of the study. Logistic regression was done to assess the association between race and low volume/very low volume hospitals. Racial disparities were further characterized using stratification by time and by the racial composition of the patient community.
  
  
  RESULTS
  A total of 8,168 patients treated with cystectomy for bladder cancer were included in analysis. Compared with white race, black race was associated with a higher likelihood of low volume/very low volume hospital use (OR 1.59, 95% CI 1.26-2.02). The disparity was most prominent in 2002 to 2006 (OR 2.51, 95% CI 1.64-3.85) but it did not persist in 2007 to 2011 (OR 1.46, 95% CI 0.92-2.32). Black patients living in a black community had the highest likelihood of low volume/very low volume hospitalization during all periods of increased regionalization (2002 to 2006 OR 4.14, 95% CI 1.84-9.34 and 2007 to 2011 OR 2.40, 95% CI 1.07-5.39).
  
  
  CONCLUSIONS
  Regionalization of cystectomy transiently worsened the racial disparity in bladder cancer care, although the disparity did not persist with time. Specific efforts may be needed to address the consequences of regionalization in particularly vulnerable subpopulations, such as black patients who live in a black community where disparities have persisted.
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Martin F
authors.initials: MF
authors.lastname: Casey
authors.affiliation: Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Tal
authors.initials: T
authors.lastname: Gross
authors.affiliation: Divisions of General Internal Medicine and Pulmonary and Critical Care, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Juan
authors.initials: J
authors.lastname: Wisnivesky
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Kristian D
authors.initials: KD
authors.lastname: Stensland
authors.affiliation: Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: William K
authors.initials: WK
authors.lastname: Oh
authors.affiliation: Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: matthew.galsky@mssm.edu.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Galsky
mesh_terms: D001741:Black or African American; D015653:Cystectomy / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D044465:White People
keywords: cystectomy; healthcare; healthcare disparities; quality indicators; regional health planning; urinary bladder neoplasms