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Facilities that service economically advantaged neighborhoods perform surgical metastasectomy more often for patients with colorectal liver metastases.
- Source :
-
Cancer [Cancer] 2020 Jan 15; Vol. 126 (2), pp. 281-292. Date of Electronic Publication: 2019 Oct 22. - Publication Year :
- 2020
-
Abstract
- Background: Metastasectomy of isolated colorectal liver metastases (CRLM) requires significant clinical expertise and may not be readily available or offered. The authors hypothesized that hospitals that treat a greater percentage of patients from higher income catchment areas are more likely to perform metastasectomies regardless of patient or tumor characteristics.<br />Methods: Using the National Cancer Data Base, the authors classified facilities into facility income quartiles (FIQs) based on the percentage of patients from the wealthiest neighborhoods (by zip code). Quartile 1 included facilities with <2.1% of the patients residing within the highest income zip codes, quartile 2 included facilities with 2.2% to 15.6% of patients residing within the highest income zip codes, quartile 3 included facilities with 15.7% to 40.2% of patients residing within the highest income zip codes, and quartile 4 included facilities with 40.3% to 90.5% of patients residing within the highest income ZIP codes. Patient, tumor, and facility characteristics were analyzed using a multivariate logistic regression to identify associations between metastasectomy and FIQ.<br />Results: Patients with CRLM were more likely to undergo metastasectomy at facilities in the highest FIQ compared with the lowest FIQ (18% vs 11% in FIQ4; P = .001). This trend was not observed in the resection of primary tumors for nonmetastatic CRLM (rates of 95% vs 93%; P = .94). After adjusting for individual insurance status, distance traveled, zip code-level individual income, tumor, and host, patients who were treated at the highest FIQ facilities were found to be more likely to undergo metastasectomy (odds ratio, 1.29; 95% CI, 1.02-1.72 [P = .03]).<br />Conclusions: Metastasectomy for CRLM is more likely to occur at facilities that serve a greater percentage of patients from high-income catchment areas, regardless of individual patient characteristics. This disparity uniquely affects those patients with advanced cancers for which specialized expertise for therapy is necessary.<br /> (© 2019 American Cancer Society.)
- Subjects :
- Adenocarcinoma secondary
Aged
Databases, Factual statistics & numerical data
Female
Healthcare Disparities economics
Hospitals statistics & numerical data
Humans
Liver Neoplasms secondary
Logistic Models
Male
Middle Aged
Retrospective Studies
United States
Adenocarcinoma surgery
Colorectal Neoplasms pathology
Healthcare Disparities statistics & numerical data
Income statistics & numerical data
Liver Neoplasms surgery
Metastasectomy statistics & numerical data
Residence Characteristics statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1097-0142
- Volume :
- 126
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Cancer
- Publication Type :
- Academic Journal
- Accession number :
- 31639217
- Full Text :
- https://doi.org/10.1002/cncr.32529