Transcript Top Ten Abstract Presentation (Section on Neuro-Oncology): Disparities in Access to Neuro-Oncological Care Nationwide.

Disparities in Referral to
Neuro-Oncological Surgery in the United States
Debraj Mukherjee, M.D., M.P.H.
Thomas A. Kosztowski, B.S.
Hasan A. Zaidi, B.S.
David C. Chang, Ph.D., M.P.H., M.B.A.
George I. Jallo, M.D.
Benjamin S. Carson, M.D.
Henry Brem, M.D.
Alfredo Quiñones-Hinojosa, M.D.
Background
It has been well established in the
literature that patients undergoing
surgical intervention at high
volume hospitals experience
significantly reduced perioperative
morbidity and mortality
Methods: Linkage
In order to link patient specific data from both the ARF and NIS,
a common 5-digit state/county modified FIPS (Federal Information Processing Standards)
code was utilized.
Methods:
Inclusion / Exclusion Criteria
• Seventeen forms of malignant or
benign brain tumors, as well as relevant
surgical procedures, helped identify
patients via ICD-9 diagnosis and
procedural codes.
• Patients age <18 years old were
excluded.
Methods:
Outcomes and Covariates
• Primary outcomes were admission to a
high-volume (>50 craniotomies/year)
hospital or admission to a teaching
hospital (Long et al, 1997)
• Covariates included patient-level,
hospital-level, and environmental
factors
Patient, county, and distribution characteristics for 76,436
brain tumor patients undergoing craniotomy, 1988-2005*
Over time, overall odds of admission to
high-volume centers for neuro-oncology
surgical treatment has steadily risen.
Odds of admission to high-volume hospitals, adjusting for age, gender, race, Charlson
score, income, insurance, percent poverty, neurosurgeon density, and year of
admission, 1988-2005.*
In total, over 18 years, African-Americans do not appear to
have any significant disparities in access relative to whites;
Hispanics are >30% less likely to be admitted to high volume
centers than white counterparts.
Examined more closely, both African-Americans and Hispanics
demonstrate dramatically worse access to high-volume centers than
white counterparts, particularly in more recent calendar years.
Conclusions
• Overall, more patients are being admitted to high-volume
centers for neurosurgical intervention for brain tumors
• Groups that continue to have relatively poor access to
high-volume centers include:
• Elderly patients
• Low SES patients
• Patients from racial/ethnic minorities
• Disparities in access to care have worsened for blacks
and Hispanics over the last two decades