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Background: Colon cancer disparities are well documented in the literature. Previous work suggests that minority clustering in certain types of hospitals may influence outcomes. The current study defines hospitals that serve high percentages of minorities in California and compares quality of care and mortality in these settings.
Hypothesis: hospitals serving high percentages of minorities have lower compliance with evidence-based care (12 lymph node exam and appropriate chemotherapy); and higher mortality rates.
Methods: Retrospective analysis of stage I-III colon cancers from California Cancer Registry (1996-2006) data linked to Discharge Data and hospital characteristics.
Outcomes: distribution of race by hospital characteristics; compliance with guidelines; trends in compliance over time; 5-year mortality by hospital characteristics.
Results: Approximately 60,000 cases in 439 hospitals were analyzed. Minorities used High percent Medicaid hospitals (HMH) and teaching hospitals. More whites used high volume hospitals (HVH). HVH (ORHVH 1.03, CIHVH [1.03, 1.04]) and teaching hospitals (ORteach1.48, CIteach [1.40, 1.56]) were associated with higher compliance with LN exam; HMH were lower (ORHMH 0.91, CIHMH [0.85, 0.98]). Chemotherapy compliance was similar: (ORHVH1.05, CIHVH [1.05, 1.06]); (ORteach1.91, CIteach [1.45, 2.52]); (ORHMH0.76, CIHMH [0.67, 0.86]). There were lower mortality rates in HVH (HRHVH 0.97, p<0.001); higher in HMH (HRHMH1.33, p <0.0001); and no difference in teaching settings.
Conclusions: Minority clustering in low performing hospitals may explain some of the observed disparity in colon cancer outcomes. Policies designed to improve the quality of colon cancer care and outcomes should target hospitals serving high proportions of minority patients.