Socioeconomic and racial differences in treatment for breast cancer at a low-volume hospital

Ann Surg Oncol. 2011 Oct;18(11):3220-7. doi: 10.1245/s10434-011-2001-z. Epub 2011 Aug 23.


Purpose: Population-based studies have revealed higher mortality among breast cancer patients treated in low-volume hospitals. Other studies have demonstrated disparities in race and socioeconomic status (SES) in breast cancer survival. The purpose of our study was to determine whether nonwhite or low-SES patients are disproportionately treated in low-volume hospitals.

Methods: A population-based cohort of 2,777 Medicare breast cancer patients who underwent breast cancer surgery in 2003 participated in a survey study examining breast cancer outcomes. Information was obtained from survey responses, Medicare claims, and state tumor registry data.

Results: On univariate analysis, patients treated at low-volume hospitals were less likely to be white, less likely to live in an urban location, and more likely to have a low SES with less social support and live a greater distance from a high-volume hospital. Education, marital status, total household income, having additional insurance besides Medicare, population density of primary residence, and tangible support were associated with distance to the nearest high-volume hospital. On multivariate analysis, the independent predictors of treatment at a low-volume hospital were being nonwhite (P = 0.003), having a lower household income (P < 0.0001), residence in a rural location (P = 0.01), and living a greater distance from a high-volume hospital (P < 0.0001).

Conclusions: In this large population-based cohort, women who were poorer, nonwhite, and who lived in a rural location or at a greater distance from a high-volume hospital were more likely to be treated at low-volume hospitals. These differences may partially explain racial and SES disparities in breast cancer outcomes.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • African Americans / statistics & numerical data*
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Breast Neoplasms / economics*
  • Breast Neoplasms / epidemiology*
  • Breast Neoplasms / surgery
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • Health Status Disparities*
  • Healthcare Disparities*
  • Hospitals / statistics & numerical data*
  • Humans
  • Mastectomy
  • Medicare
  • Prognosis
  • Rural Population
  • Socioeconomic Factors
  • United States / epidemiology