African Americans and Hispanic patients appear less likely than white patients to have access to high-quality surgical care for brain tumors, according to a report in the March issue of Archives of Surgery, one of the JAMA/Archives journals.
The article is one of several in the issue focusing on cancer, and is being published in conjunction with a JAMA theme issue on cancer. The March issues of Archives of Pediatrics & Adolescent Medicine, Archives of Neurology, Archives of Internal Medicine, Archives of Ophthalmology, Archives of Dermatology, Archives of Facial Plastic Surgery and Archives of Otolaryngology-Head & Neck Surgery will also publish articles on this theme.
"Over the past decade, numerous studies have examined the association between treatment at high-volume hospitals and improved outcomes," the authors write as background information in the article. The association between volume and quality of care has been observed in several surgical subspecialties, including neurosurgery.
Debraj Mukherjee, M.D., M.P.H., and colleagues at the Johns Hopkins School of Medicine, Baltimore, analyzed data from 76,436 patients who underwent craniotomy--a surgical procedure involving opening a flap in the skull--to biopsy or remove a brain tumor between 1988 and 2005. Details about the patients' socioeconomic background and environment were obtained from a separate database and linked to the discharge information. High-volume hospitals were defined as those that performed more than 50 such procedures per year.
Overall, 25,481 patients (33.3 percent) were admitted to high-volume hospitals, and access to these facilities improved over time. However, disparities in access to care by race increased. "In the late 1980s and early 1990s, African Americans and Hispanics had similar or slightly higher odds for admission to high-volume hospitals compared with whites," the authors write. "Following a steady decline over time, African Americans and Hispanics were significantly less likely to be admitted to high-volume hospitals over the last four years examined (2001 to 2005)."
Access to high-volume hospitals was better in counties with more neurosurgeons or a higher median (midpoint) household income. Access was decreased among patients who were older, had more co-occurring illnesses or lived in counties with higher poverty rates.
"In conclusion, our unique method of linking two large administrative databases identified previously unstudied countywide socioeconomic and environmental factors that have a critical role in access to quality health care in the United States," the authors write. "Elimination of health care barriers by targeted means remains essential to the practice of modern medicine. Prospective studies may more fully elucidate the causes of the trends identified in this study to ensure that targeted interventions improve access to specialized neuro-oncologic care throughout the United States in the years to come."
Other articles featured in this issue find:
- Decitabane, a compound that affects genetic expression, appears to inhibit the growth of cells that form tumors in the adrenal gland (in a rare but aggressive malignancy known as adrenocortical carcinoma)
- Adding chemotherapy to surgery may be feasible and effective for patients with high-risk, advanced-stage gastric cancer
(Arch Surg. 2010;145:247-253, 226-232, 233-238. Available pre-embargo to the media at www.jamamedia.org.)
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