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

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. Cancer 2012. © 2012 American Cancer Society.