title: Racial Disparities in Partial Nephrectomy Persist Across Hospital Types: Results From a Population-based Cohort.
abstract: OBJECTIVE
  To assess the national utilization of partial nephrectomy (PN) for T1a renal masses across different racial groups by hospital type. Although clinical guidelines recommend PN for small renal masses (SRMs), racial disparities persist in the use of PN. High-volume and academic hospitals have been associated with greater use of PN for SRMs. However, it is unknown whether racial disparities persist in the use of PN across different types of hospitals.
  
  
  METHODS
  Using the National Cancer Database, we identified patients with localized T1a renal cancer (≤4 cm) from 1998 to 2011. The primary outcome was receipt of PN among patients surgically treated for SRMs. Multivariable logistic regression analyses were used to assess for racial differences in treatment with PN stratified by hospital characteristics.
  
  
  RESULTS
  Among 118,207 patients diagnosed with clinical T1a renal masses, 36.5% underwent PN (n = 43,134). Overall, a greater proportion of white patients underwent PN (37.3%) compared with African-American (32.4%) and Hispanic (33.7%) patients with SRMs (P <.001). When stratified by hospital type, disparities persisted in the use of PN; African-American patients had lower adjusted odds ratios for being treated with PN when treated at comprehensive community cancer (odds ratio: 0.90; P = .003) and academic (odds ratio: 0.65; P <.001) hospitals compared with white patients.
  
  
  CONCLUSIONS
  In this population-based cohort, we found that racial disparities persist across all types of hospitals in the use of PN for SRMs. Further research is needed to identify, and target for intervention, the factors contributing to racial disparities in the surgical management of SRMs.
authors.affiliation: University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Kiechle
authors.affiliation: University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH.
authors.forename: Robert
authors.initials: R
authors.lastname: Abouassaly
authors.affiliation: Department of Internal Medicine, Yale University, New Haven, CT; Cancer Outcomes and Public Policy Effectiveness Research (COPPER) Center, Yale University, New Haven, CT.
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
authors.affiliation: University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH.
authors.forename: Shan
authors.initials: S
authors.lastname: Dong
authors.affiliation: University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH.
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cherullo
authors.affiliation: Louis Stokes Veterans Affairs Medical Center, Cleveland, OH; Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Division of Urologic Surgery, Harvard Medical School, Boston, MA.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.affiliation: University of Montreal, QC, Canada.
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.affiliation: University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH.
authors.forename: Neal J
authors.initials: NJ
authors.lastname: Meropol
authors.affiliation: University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hoimes
authors.affiliation: University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ialacci
authors.affiliation: University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH; Department of Internal Medicine, Yale University, New Haven, CT. Electronic address: simkim@me.com.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino; D006761:Hospitals; D006801:Humans; D008875:Middle Aged; D009392:Nephrectomy / Q000706:statistics & numerical data*; D044465:White People; D055815:Young Adult