Ethnic/racial disparities in hospital procedure volume for lung resection for lung cancer

Charles J. Neighbors, Michelle L. Rogers, Edmond D. Shenassa, Christopher N. Sciamanna, Melissa A. Clark, Scott P. Novak

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

BACKGROUND:: Ethnic/racial minorities experience poorer outcomes from lung cancer than non-Hispanic whites. Higher hospital procedure volume is associated with better survival from lung resection for lung cancer. OBJECTIVES:: We examined whether (1) ethnic/racial minorities are more likely to obtain lung resections at lower volume hospitals, (2) ethnicity/race is associated with inpatient mortality, (3) hospital volume mediates this association, and (4) hospital selection is mediated by racial/ethnic segregation, differences in insurance coverage, or limited hospital choice. METHODS:: Six years of data from the Nationwide Inpatient Sample (NIS 1998ĝ€"2003, unweighted n ≤ 50,245, weighted n ≤ 129,506) were used in multivariate models controlling for sociodemographic factors, case complexity, and hospital characteristics. Additional analyses were conducted using the Area Resource File, which provided data on ethnic density and number of surgical hospitals in the hospital region. RESULTS:: Blacks/African Americans (odds ratio [OR] ≤ 0.45; 0.34ĝ€"0.58) and Latinos (OR ≤ 0.44; 0.32ĝ€"0.63) had lower odds of obtaining lung resection at a high-volume hospital than non-Hispanic whites. Blacks/African Americans (OR ≤ 1.30; 1.01ĝ€"1.67), Latinos (OR ≤ 1.41; 1. 02ĝ€"1.94), and other racial/ethnic minorities (OR ≤ 1.46; 1.04ĝ€"2.06) also had higher odds of dying in hospital, but this association was statistically nonsignificant after controlling for hospital volume. Hospital location was not associated with lung resection procedure volume, nor did location mediate the association between ethnicity/race and hospital volume. CONCLUSIONS:: Ethnic/racial minorities are obtaining lung resection in lower volume hospitals and are more likely to die in hospital. Hospital volume is associated with higher mortality, but health insurance, segregation, and number of surgical hospitals within a county do not account for observed disparities.

Original languageEnglish (US)
Pages (from-to)655-663
Number of pages9
JournalMedical care
Volume45
Issue number7
DOIs
StatePublished - Jul 1 2007

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Lung Neoplasms
Lung
Odds Ratio
High-Volume Hospitals
Hispanic Americans
African Americans
Inpatients
Insurance Coverage
Health Insurance
Hospital Mortality

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health

Cite this

Neighbors, Charles J. ; Rogers, Michelle L. ; Shenassa, Edmond D. ; Sciamanna, Christopher N. ; Clark, Melissa A. ; Novak, Scott P. / Ethnic/racial disparities in hospital procedure volume for lung resection for lung cancer. In: Medical care. 2007 ; Vol. 45, No. 7. pp. 655-663.
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abstract = "BACKGROUND:: Ethnic/racial minorities experience poorer outcomes from lung cancer than non-Hispanic whites. Higher hospital procedure volume is associated with better survival from lung resection for lung cancer. OBJECTIVES:: We examined whether (1) ethnic/racial minorities are more likely to obtain lung resections at lower volume hospitals, (2) ethnicity/race is associated with inpatient mortality, (3) hospital volume mediates this association, and (4) hospital selection is mediated by racial/ethnic segregation, differences in insurance coverage, or limited hospital choice. METHODS:: Six years of data from the Nationwide Inpatient Sample (NIS 1998ĝ€{"}2003, unweighted n ≤ 50,245, weighted n ≤ 129,506) were used in multivariate models controlling for sociodemographic factors, case complexity, and hospital characteristics. Additional analyses were conducted using the Area Resource File, which provided data on ethnic density and number of surgical hospitals in the hospital region. RESULTS:: Blacks/African Americans (odds ratio [OR] ≤ 0.45; 0.34ĝ€{"}0.58) and Latinos (OR ≤ 0.44; 0.32ĝ€{"}0.63) had lower odds of obtaining lung resection at a high-volume hospital than non-Hispanic whites. Blacks/African Americans (OR ≤ 1.30; 1.01ĝ€{"}1.67), Latinos (OR ≤ 1.41; 1. 02ĝ€{"}1.94), and other racial/ethnic minorities (OR ≤ 1.46; 1.04ĝ€{"}2.06) also had higher odds of dying in hospital, but this association was statistically nonsignificant after controlling for hospital volume. Hospital location was not associated with lung resection procedure volume, nor did location mediate the association between ethnicity/race and hospital volume. CONCLUSIONS:: Ethnic/racial minorities are obtaining lung resection in lower volume hospitals and are more likely to die in hospital. Hospital volume is associated with higher mortality, but health insurance, segregation, and number of surgical hospitals within a county do not account for observed disparities.",
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Ethnic/racial disparities in hospital procedure volume for lung resection for lung cancer. / Neighbors, Charles J.; Rogers, Michelle L.; Shenassa, Edmond D.; Sciamanna, Christopher N.; Clark, Melissa A.; Novak, Scott P.

In: Medical care, Vol. 45, No. 7, 01.07.2007, p. 655-663.

Research output: Contribution to journalArticle

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T1 - Ethnic/racial disparities in hospital procedure volume for lung resection for lung cancer

AU - Neighbors, Charles J.

AU - Rogers, Michelle L.

AU - Shenassa, Edmond D.

AU - Sciamanna, Christopher N.

AU - Clark, Melissa A.

AU - Novak, Scott P.

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N2 - BACKGROUND:: Ethnic/racial minorities experience poorer outcomes from lung cancer than non-Hispanic whites. Higher hospital procedure volume is associated with better survival from lung resection for lung cancer. OBJECTIVES:: We examined whether (1) ethnic/racial minorities are more likely to obtain lung resections at lower volume hospitals, (2) ethnicity/race is associated with inpatient mortality, (3) hospital volume mediates this association, and (4) hospital selection is mediated by racial/ethnic segregation, differences in insurance coverage, or limited hospital choice. METHODS:: Six years of data from the Nationwide Inpatient Sample (NIS 1998ĝ€"2003, unweighted n ≤ 50,245, weighted n ≤ 129,506) were used in multivariate models controlling for sociodemographic factors, case complexity, and hospital characteristics. Additional analyses were conducted using the Area Resource File, which provided data on ethnic density and number of surgical hospitals in the hospital region. RESULTS:: Blacks/African Americans (odds ratio [OR] ≤ 0.45; 0.34ĝ€"0.58) and Latinos (OR ≤ 0.44; 0.32ĝ€"0.63) had lower odds of obtaining lung resection at a high-volume hospital than non-Hispanic whites. Blacks/African Americans (OR ≤ 1.30; 1.01ĝ€"1.67), Latinos (OR ≤ 1.41; 1. 02ĝ€"1.94), and other racial/ethnic minorities (OR ≤ 1.46; 1.04ĝ€"2.06) also had higher odds of dying in hospital, but this association was statistically nonsignificant after controlling for hospital volume. Hospital location was not associated with lung resection procedure volume, nor did location mediate the association between ethnicity/race and hospital volume. CONCLUSIONS:: Ethnic/racial minorities are obtaining lung resection in lower volume hospitals and are more likely to die in hospital. Hospital volume is associated with higher mortality, but health insurance, segregation, and number of surgical hospitals within a county do not account for observed disparities.

AB - BACKGROUND:: Ethnic/racial minorities experience poorer outcomes from lung cancer than non-Hispanic whites. Higher hospital procedure volume is associated with better survival from lung resection for lung cancer. OBJECTIVES:: We examined whether (1) ethnic/racial minorities are more likely to obtain lung resections at lower volume hospitals, (2) ethnicity/race is associated with inpatient mortality, (3) hospital volume mediates this association, and (4) hospital selection is mediated by racial/ethnic segregation, differences in insurance coverage, or limited hospital choice. METHODS:: Six years of data from the Nationwide Inpatient Sample (NIS 1998ĝ€"2003, unweighted n ≤ 50,245, weighted n ≤ 129,506) were used in multivariate models controlling for sociodemographic factors, case complexity, and hospital characteristics. Additional analyses were conducted using the Area Resource File, which provided data on ethnic density and number of surgical hospitals in the hospital region. RESULTS:: Blacks/African Americans (odds ratio [OR] ≤ 0.45; 0.34ĝ€"0.58) and Latinos (OR ≤ 0.44; 0.32ĝ€"0.63) had lower odds of obtaining lung resection at a high-volume hospital than non-Hispanic whites. Blacks/African Americans (OR ≤ 1.30; 1.01ĝ€"1.67), Latinos (OR ≤ 1.41; 1. 02ĝ€"1.94), and other racial/ethnic minorities (OR ≤ 1.46; 1.04ĝ€"2.06) also had higher odds of dying in hospital, but this association was statistically nonsignificant after controlling for hospital volume. Hospital location was not associated with lung resection procedure volume, nor did location mediate the association between ethnicity/race and hospital volume. CONCLUSIONS:: Ethnic/racial minorities are obtaining lung resection in lower volume hospitals and are more likely to die in hospital. Hospital volume is associated with higher mortality, but health insurance, segregation, and number of surgical hospitals within a county do not account for observed disparities.

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