Disparities in access to care at high-volume institutions for uro-oncologic procedures

Cancer. 2012 Sep 15;118(18):4421-6. doi: 10.1002/cncr.27440. Epub 2012 Feb 1.


Background: Socioeconomic status represents an established barrier to health care access. Age, sex, and race may also play a role. The authors examined whether these affect the access to high-volume hospitals for uro-oncologic procedures in the United States.

Methods: Within the Nationwide Inpatient Sample (NIS), the authors focused on radical prostatectomy (RP), radical cystectomy, and nephrectomy (Nx) performed within the 5 most contemporary years (2003-2007). Logistic regression models were used to estimate the impact of the primary predictors on the likelihood of receiving care at a high-volume hospital.

Results: Between 2003 and 2007, 62,165 RP, 6557 radical cystectomy, and 28,062 Nx cases were recorded within the NIS. Patient age (P = .001), year of surgery (P = .001), Charlson Comorbidity Index (P ≤ .025), median Zip Code income (highest vs lowest quartile, P = .001), and insurance status (private vs Medicare, P = .008) were independent predictors of being treated at high-volume institutions. Moreover, black race was an independent predictor of decreased utilization of high-volume institutions for radical cystectomy (P = .012), and female sex was an independent predictor of decreased utilization of high-volume institutions for Nx (P = .016).

Conclusions: On average, old, sick, poor, and Medicare patients were less likely to be treated at high-volume hospitals for uro-oncologic surgery. Similarly, black patients were less likely to have a radical cystectomy at a high-volume hospital, and female patients were less likely to have an Nx at a high-volume hospital. Selective referral of individuals who are less likely to receive care at such institutions may represent a health care priority intended to optimize outcomes across all population strata.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cystectomy
  • Female
  • Health Services Accessibility / statistics & numerical data*
  • Healthcare Disparities*
  • Hospitals
  • Hospitals, High-Volume*
  • Humans
  • Insurance Coverage
  • Male
  • Medicare
  • Nephrectomy
  • Prostatectomy
  • Racial Groups
  • United States
  • Urologic Neoplasms / surgery*
  • Urologic Surgical Procedures*