Premium
Disparities in Laryngeal Cancer Treatment and Outcomes: An Analysis by Hospital Safety‐Net Burden
Author(s) -
Qureshi Muhammad M.,
Oladeru Oluwadamilola T.,
Lam Christa M.,
Dyer Michael A.,
Mak Kimberley S.,
Hirsch Ariel E.,
Truong Minh Tam
Publication year - 2021
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.29416
Subject(s) - medicine , hazard ratio , medicaid , proportional hazards model , quartile , cohort , survival analysis , confidence interval , multivariate analysis , cancer , health care , economics , economic growth
Objectives/Hypothesis To analyze the impact of hospital safety‐net burden on survival outcomes for laryngeal squamous cell carcinoma (LSCC) patients. Study Design Retrospective cohort study. Methods From 2004 to 2015, 59,733 LSCC patients treated with curative intent were identified using the National Cancer Database. Low (LBH) <25th, medium (MBH) 25th–75th, and high (HBH) >75th safety‐net burden hospitals were defined by the percentage quartiles (%) of uninsured/Medicaid‐insured patients treated. Social and clinicopathologic characteristics and overall survival (using Kaplan–Meier survival analysis) were evaluated. Crude and adjusted hazard ratios (HR) with 95% confidence intervals (CI) were computed using Cox regression modeling. Results There were 324, 647, and 323 hospitals that met the criteria as LBH, MBH, and HBH, respectively. The median follow‐up was 38.6 months. A total of 27,629 deaths were reported, with a median survival of 75.8 months (a 5‐year survival rate of 56.6%). Median survival was 83.2, 77.8, and 69.3 months for patients from LBH, MBH, and HBH, respectively ( P < .0001). The median % of uninsured/Medicaid‐insured patients treated among LBH, MBH, and HBH were 3.6%, 14.0%, and 27.0%, respectively. Patients treated at HBH were significantly more likely to be young, Black, Hispanic, of low income, and present with more advanced disease compared to LBH and MBH. Survival was comparable for LBH and MBH (HR = 1.02; 95% CI = 0.97–1.07, P = .408) on multivariate analysis. HBH, compared to LBH patients, had inferior survival (HR = 1.07; 95% CI = 1.01–1.13, P = .023). Conclusions High burden safety‐net hospitals receive disproportionately more patients with advanced‐stage and low socioeconomic status, yielding inferior survival compared to low burden hospitals. Level of Evidence 3 (individual cohort study) Laryngoscope , 131:E1987–E1997, 2021