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Ethnic/Racial Disparities in Hospital Procedure Volume for Lung Resection for Lung Cancer

Neighbors, Charles J. PhD, MBA*; Rogers, Michelle L. PhD; Shenassa, Edmond D. ScD; Sciamanna, Christopher N. MD, MPH§; Clark, Melissa A. PhD†§; Novak, Scott P. PhD

doi: 10.1097/MLR.0b013e3180326110
Original Article

Background: Ethnic/racial minorities experience poorer outcomes from lung cancer than non-Hispanic whites. Higher hospital procedure volume is associated with better survival from lung resection for lung cancer.

Objectives: We examined whether (1) ethnic/racial minorities are more likely to obtain lung resections at lower volume hospitals, (2) ethnicity/race is associated with inpatient mortality, (3) hospital volume mediates this association, and (4) hospital selection is mediated by racial/ethnic segregation, differences in insurance coverage, or limited hospital choice.

Methods: Six years of data from the Nationwide Inpatient Sample (NIS 1998–2003, unweighted n = 50,245, weighted n = 129,506) were used in multivariate models controlling for sociodemographic factors, case complexity, and hospital characteristics. Additional analyses were conducted using the Area Resource File, which provided data on ethnic density and number of surgical hospitals in the hospital region.

Results: Blacks/African Americans (odds ratio [OR] = 0.45; 0.34–0.58) and Latinos (OR = 0.44; 0.32–0.63) had lower odds of obtaining lung resection at a high-volume hospital than non-Hispanic whites. Blacks/African Americans (OR = 1.30; 1.01–1.67), Latinos (OR = 1.41; 1.02–1.94), and other racial/ethnic minorities (OR = 1.46; 1.04–2.06) also had higher odds of dying in hospital, but this association was statistically nonsignificant after controlling for hospital volume. Hospital location was not associated with lung resection procedure volume, nor did location mediate the association between ethnicity/race and hospital volume.

Conclusions: Ethnic/racial minorities are obtaining lung resection in lower volume hospitals and are more likely to die in hospital. Hospital volume is associated with higher mortality, but health insurance, segregation, and number of surgical hospitals within a county do not account for observed disparities.

From *The National Center on Addiction and Substance Abuse at Columbia University, New York, New York; †Center for Gerontology and Healthcare Research, ‡Department of Community Health, Brown University, Providence, Rhode Island; §Department of Health Policy, Jefferson Medical College, Philadelphia, Pennsylvania; ¶Division of Health, Social, and Economic Research, Research Triangle Institute, Research Triangle Park, North Carolina.

Supported by a National Cancer Institute career development grant CA K07 909961 (to CJN).

Reprints: Charles J. Neighbors, PhD, MBA, The National Center on Addiction and Substance Abuse (CASA) at Columbia University, 633 Third Avenue, 19th Floor, New York, NY 10017. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.