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From the Archives
September 2010

Apparent Widening Gap in Access to Neuro-oncologic Care in the United StatesNeed for Action

Author Affiliations

Author Affiliations: Division of Neurosurgery, Department of Surgery (Dr Riley), Departments of Neurology (Dr Fathallah-Shaykh), Mathematics (Dr Fathallah-Shaykh), Cell Biology (Dr Fathallah-Shaykh), and Biomedical Engineering (Dr Fathallah-Shaykh), and The UAB Comprehensive Neuroscience and Cancer Centers (Dr Fathallah-Shaykh), The University of Alabama at Birmingham.

Arch Neurol. 2010;67(9):1137-1139. doi:10.1001/archneurol.2010.217

Archives of Surgery

Disparities in Access to Neuro-oncologic Care in the United States

Debraj Mukherjee, MD, MPH; Hasan A. Zaidi, BS; Thomas Kosztowski, BS; Kaisorn L. Chaichana, MD; Henry Brem, MD; David C. Chang, PhD, MPH, MBA; Alfredo Quiñones-Hinojosa, MD

Hypothesis:   Race/ethnicity and social status influence admission to high-volume hospitals among patients who undergo craniotomy for tumor biopsy or resection.

Design:   Retrospective analysis of the Nationwide Inpatient Sample (1988-2005), with additional factors from the Area Resource File.

Setting:   A 20% representative sample of all hospitals in 37 US states.

Patients:   A total of 76 436 patients 18 years or older who were admitted and underwent craniotomy for tumor biopsy or resection.

Main Outcome Measures:   Odds ratios (ORs) for the association of age, sex, race/ethnicity, insurance status, Charlson Comorbidity Index, and county-level characteristics with admission to high-volume hospitals (>50 craniotomies per year) or low-volume hospitals.

Results:   A total of 25 481 patients (33.3%) were admitted to high-volume hospitals. Overall access to high-volume hospitals improved over time. However, racial/ethnic disparities in access to high-volume hospitals dramatically worsened for Hispanics (OR, 0.49) and African Americans (OR, 0.62) in recent years. Factors associated with better access to high-volume hospitals included years since 1988 (OR, 1.11), greater countywide neurosurgeon density (OR, 1.66), and higher countywide median household income (OR, 1.71). Factors associated with worse access to high-volume hospitals included older age (OR, 0.34 per year increase), increased countywide poverty rate (OR, 0.57), Hispanic race/ethnicity (OR, 0.68), and higher Charlson Comorbidity Index (OR, 0.96 per point increase).

Conclusions:   African Americans and Hispanics have disproportionately worse access to high-quality neuro-oncologic care over time compared with whites. Higher countywide median household income and decreased countywide poverty rate were associated with better access to high-volume hospitals, implicating socioeconomic factors in predicting admission to high-quality centers.

Arch Surg. 2010;145(3):247-253.