Racial variation in the quality of surgical care for bladder cancer

Daniel A. Barocas, Joann Alvarez, Tatsuki Koyama, Christopher B. Anderson, Darryl T. Gray, Jay Fowke, Chaochen You, Sam S. Chang, Michael S. Cookson, Joseph A. Smith, David F. Penson

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

BACKGROUND Differences in quality of care may contribute to racial variation in outcomes of bladder cancer (BCa). Quality indicators in patients undergoing surgery for BCa include the use of high-volume surgeons and high-volume hospitals, and, when clinically indicated, receipt of pelvic lymphadenectomy, receipt of continent urinary diversion, and undergoing radical cystectomy instead of partial cystectomy. The authors compared these quality indicators as well as adverse perioperative outcomes in black patients and white patients with BCa. METHODS The Healthcare Cost and Utilization Project State Inpatient Databases for New York, Florida, and Maryland (1996-2009) were used, because they consistently included race, surgeon, and hospital identifiers. Quality indicators were compared across racial groups using regression models adjusting for age, sex, Elixhauser comorbidity sum, insurance, state, and year of surgery, accounting for clustering within hospital. RESULTS Black patients were treated more often by lower volume surgeons and hospitals, they had significantly lower receipt of pelvic lymphadenectomy and continent diversion, and they experienced higher rates of adverse outcomes compared with white patients. These associations remained significant for black patients who received treatment from surgeons and at hospitals in the top volume decile. CONCLUSIONS Black patients with BCa had lower use of experienced providers and institutions for BCa surgery. In addition, the quality of care for black patients was lower than that for whites even if they received treatment in a high-volume setting. This gap in quality of care requires further investigation.

Original languageEnglish (US)
Pages (from-to)1018-1025
Number of pages8
JournalCancer
Volume120
Issue number7
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Quality of Health Care
Urinary Bladder Neoplasms
Cystectomy
Lymph Node Excision
High-Volume Hospitals
Urinary Diversion
Insurance
Health Care Costs
Cluster Analysis
Comorbidity
Inpatients
Databases
Surgeons
Therapeutics

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Barocas, D. A., Alvarez, J., Koyama, T., Anderson, C. B., Gray, D. T., Fowke, J., ... Penson, D. F. (2014). Racial variation in the quality of surgical care for bladder cancer. Cancer, 120(7), 1018-1025. https://doi.org/10.1002/cncr.28520

Racial variation in the quality of surgical care for bladder cancer. / Barocas, Daniel A.; Alvarez, Joann; Koyama, Tatsuki; Anderson, Christopher B.; Gray, Darryl T.; Fowke, Jay; You, Chaochen; Chang, Sam S.; Cookson, Michael S.; Smith, Joseph A.; Penson, David F.

In: Cancer, Vol. 120, No. 7, 01.01.2014, p. 1018-1025.

Research output: Contribution to journalArticle

Barocas, DA, Alvarez, J, Koyama, T, Anderson, CB, Gray, DT, Fowke, J, You, C, Chang, SS, Cookson, MS, Smith, JA & Penson, DF 2014, 'Racial variation in the quality of surgical care for bladder cancer', Cancer, vol. 120, no. 7, pp. 1018-1025. https://doi.org/10.1002/cncr.28520
Barocas DA, Alvarez J, Koyama T, Anderson CB, Gray DT, Fowke J et al. Racial variation in the quality of surgical care for bladder cancer. Cancer. 2014 Jan 1;120(7):1018-1025. https://doi.org/10.1002/cncr.28520
Barocas, Daniel A. ; Alvarez, Joann ; Koyama, Tatsuki ; Anderson, Christopher B. ; Gray, Darryl T. ; Fowke, Jay ; You, Chaochen ; Chang, Sam S. ; Cookson, Michael S. ; Smith, Joseph A. ; Penson, David F. / Racial variation in the quality of surgical care for bladder cancer. In: Cancer. 2014 ; Vol. 120, No. 7. pp. 1018-1025.
@article{c405582984ab4e43860bfeb2fe0f6f9b,
title = "Racial variation in the quality of surgical care for bladder cancer",
abstract = "BACKGROUND Differences in quality of care may contribute to racial variation in outcomes of bladder cancer (BCa). Quality indicators in patients undergoing surgery for BCa include the use of high-volume surgeons and high-volume hospitals, and, when clinically indicated, receipt of pelvic lymphadenectomy, receipt of continent urinary diversion, and undergoing radical cystectomy instead of partial cystectomy. The authors compared these quality indicators as well as adverse perioperative outcomes in black patients and white patients with BCa. METHODS The Healthcare Cost and Utilization Project State Inpatient Databases for New York, Florida, and Maryland (1996-2009) were used, because they consistently included race, surgeon, and hospital identifiers. Quality indicators were compared across racial groups using regression models adjusting for age, sex, Elixhauser comorbidity sum, insurance, state, and year of surgery, accounting for clustering within hospital. RESULTS Black patients were treated more often by lower volume surgeons and hospitals, they had significantly lower receipt of pelvic lymphadenectomy and continent diversion, and they experienced higher rates of adverse outcomes compared with white patients. These associations remained significant for black patients who received treatment from surgeons and at hospitals in the top volume decile. CONCLUSIONS Black patients with BCa had lower use of experienced providers and institutions for BCa surgery. In addition, the quality of care for black patients was lower than that for whites even if they received treatment in a high-volume setting. This gap in quality of care requires further investigation.",
author = "Barocas, {Daniel A.} and Joann Alvarez and Tatsuki Koyama and Anderson, {Christopher B.} and Gray, {Darryl T.} and Jay Fowke and Chaochen You and Chang, {Sam S.} and Cookson, {Michael S.} and Smith, {Joseph A.} and Penson, {David F.}",
year = "2014",
month = "1",
day = "1",
doi = "10.1002/cncr.28520",
language = "English (US)",
volume = "120",
pages = "1018--1025",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "7",

}

TY - JOUR

T1 - Racial variation in the quality of surgical care for bladder cancer

AU - Barocas, Daniel A.

AU - Alvarez, Joann

AU - Koyama, Tatsuki

AU - Anderson, Christopher B.

AU - Gray, Darryl T.

AU - Fowke, Jay

AU - You, Chaochen

AU - Chang, Sam S.

AU - Cookson, Michael S.

AU - Smith, Joseph A.

AU - Penson, David F.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - BACKGROUND Differences in quality of care may contribute to racial variation in outcomes of bladder cancer (BCa). Quality indicators in patients undergoing surgery for BCa include the use of high-volume surgeons and high-volume hospitals, and, when clinically indicated, receipt of pelvic lymphadenectomy, receipt of continent urinary diversion, and undergoing radical cystectomy instead of partial cystectomy. The authors compared these quality indicators as well as adverse perioperative outcomes in black patients and white patients with BCa. METHODS The Healthcare Cost and Utilization Project State Inpatient Databases for New York, Florida, and Maryland (1996-2009) were used, because they consistently included race, surgeon, and hospital identifiers. Quality indicators were compared across racial groups using regression models adjusting for age, sex, Elixhauser comorbidity sum, insurance, state, and year of surgery, accounting for clustering within hospital. RESULTS Black patients were treated more often by lower volume surgeons and hospitals, they had significantly lower receipt of pelvic lymphadenectomy and continent diversion, and they experienced higher rates of adverse outcomes compared with white patients. These associations remained significant for black patients who received treatment from surgeons and at hospitals in the top volume decile. CONCLUSIONS Black patients with BCa had lower use of experienced providers and institutions for BCa surgery. In addition, the quality of care for black patients was lower than that for whites even if they received treatment in a high-volume setting. This gap in quality of care requires further investigation.

AB - BACKGROUND Differences in quality of care may contribute to racial variation in outcomes of bladder cancer (BCa). Quality indicators in patients undergoing surgery for BCa include the use of high-volume surgeons and high-volume hospitals, and, when clinically indicated, receipt of pelvic lymphadenectomy, receipt of continent urinary diversion, and undergoing radical cystectomy instead of partial cystectomy. The authors compared these quality indicators as well as adverse perioperative outcomes in black patients and white patients with BCa. METHODS The Healthcare Cost and Utilization Project State Inpatient Databases for New York, Florida, and Maryland (1996-2009) were used, because they consistently included race, surgeon, and hospital identifiers. Quality indicators were compared across racial groups using regression models adjusting for age, sex, Elixhauser comorbidity sum, insurance, state, and year of surgery, accounting for clustering within hospital. RESULTS Black patients were treated more often by lower volume surgeons and hospitals, they had significantly lower receipt of pelvic lymphadenectomy and continent diversion, and they experienced higher rates of adverse outcomes compared with white patients. These associations remained significant for black patients who received treatment from surgeons and at hospitals in the top volume decile. CONCLUSIONS Black patients with BCa had lower use of experienced providers and institutions for BCa surgery. In addition, the quality of care for black patients was lower than that for whites even if they received treatment in a high-volume setting. This gap in quality of care requires further investigation.

UR - http://www.scopus.com/inward/record.url?scp=84899453976&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84899453976&partnerID=8YFLogxK

U2 - 10.1002/cncr.28520

DO - 10.1002/cncr.28520

M3 - Article

VL - 120

SP - 1018

EP - 1025

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 7

ER -