title: Demographic and other characteristics of nodal non-Hodgkin's lymphoma managed in academic versus non-academic centers.
abstract: BACKGROUND
  Cancer therapy and outcomes are known to be affected by various demographic features and hospital types. We aimed to identify the characteristics of non-Hodgkin's lymphoma (NHL) patients associated with receipt of care at academic centers.
  
  
  METHODS
  This is a retrospective study of all patients diagnosed with nodal NHL between 2000 and 2011 in the National Cancer Database (NCDB), who received the diagnosis, and all or part of their initial therapy in the reporting hospital (n = 243,436). Characteristics of patients receiving care in academic versus nonacademic centers were compared using the Chi-square test.
  
  
  RESULTS
  Approximately 27% received care in academic centers. Patients receiving care in nonacademic centers, compared with academic centers, were more likely to be ⩾60 years (69% versus 58%, p < .0001), White (89% versus 80%, p < .0001) and have lower educational attainment (>12% without high school diploma: 72% versus 69%, p < .0001) and economic status (household income <$49,000: 66% versus 61%, p < 0.0001). Patients receiving care in nonacademic centers were less likely to travel ⩾25 miles (21% versus 26%, p < 0.0001). White patients, compared with non-Whites, were more likely to be ⩾60 years (70% versus <50%, p < 0.0001), which probably explains less care in academic centers.
  
  
  CONCLUSIONS
  Patients ⩾60 years and those with poorer educational attainment and economic status were less likely to receive care in academic centers. Care in academic centers required a longer commute. Elderly patients frequently have inferior outcomes and may benefit from clinical trials with novel agents and expertise at academic centers.
authors.affiliation: Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, 987680 Nebraska Medical Center, Omaha, NE 68198-7680, USA.
authors.forename: Vijaya Raj
authors.initials: VR
authors.lastname: Bhatt
authors.affiliation: Department of Medicine, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal.
authors.forename: Prajwal
authors.initials: P
authors.lastname: Dhakal
authors.affiliation: Department of Internal Medicine, Interfaith Medical Center, NY, USA.
authors.forename: Sumit
authors.initials: S
authors.lastname: Dahal
authors.affiliation: Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Smith
authors.initials: S
authors.lastname: Giri
authors.affiliation: Department of Medicine, Reading Health System, Reading, PA, USA.
authors.forename: Ranjan
authors.initials: R
authors.lastname: Pathak
authors.affiliation: Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: R Gregory
authors.initials: RG
authors.lastname: Bociek
authors.affiliation: Department of Internal Medicine, Division of Hematology-Oncology, Creighton University Medical Center, Omaha, NE, USA.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Silberstein
authors.affiliation: Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: James O
authors.initials: JO
authors.lastname: Armitage
keywords: academic center; clinical trial participation; elderly patient; non-Hodgkin’s lymphoma; outcome