title: Regional variation in head and neck cancer mortality: Role of patient and hospital characteristics.
abstract: The purpose of this study was to determine whether outcomes in head and neck cancer would vary based on geographic location of patients.
  
  
  
  A dataset from the California Cancer Registry was linked to publicly available discharge abstracts. Patients were separated into geographic areas based on health service areas (HSAs). Multilevel logistic regression models were constructed to include geographic, patient, and hospital-level characteristics.
  
  
  
  There was significant variation in 5-year survival hazard ratios (HRs) among the majority of the 14 HSAs in the unadjusted model. After adjusting for patient and hospital characteristics, the differences between regions were not significant except for Orange County (HR = 0.75). Commission on Cancer certification (HR = 0.82; p < .01) and hospital volume (HR = 0.975; p < .01) were each independently associated with differences in survival.
  
  
  
  Geographic variation in 5-year survival outcomes is seen in head and neck cancer. Patient characteristics and treating hospitals explain much of this variation. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1896-E1902, 2016.
authors.affiliation: Department of Otolaryngology, Division of Head and Neck Surgery, Stanford University, Palo Alto, California.
authors.forename: Vasu
authors.initials: V
authors.lastname: Divi
authors.affiliation: Department of Surgery Stanford Cancer Institute, Stanford University, Palo Alto, California.
authors.forename: Yifei
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Department of Surgery Stanford Cancer Institute, Stanford University, Palo Alto, California.
authors.forename: Kim F
authors.initials: KF
authors.lastname: Rhoads
mesh_terms: D000368:Aged; D002140:California / Q000453:epidemiology; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models
keywords: geographic; head and neck cancer; hospital volume; outcomes; quality of care; variation