Minorities With Cancer Not Using High-Volume Hospitals

Laird Harrison

November 11, 2014

SAN FRANCISCO — Cancer patients from an ethnic minority don't use high-volume hospitals in the United States as much as white patients, even though they live just as close, a new study shows. Socioeconomic factors, such as poverty and education level, could contribute to this difference.

This is important because ethnic minorities fare worse after diagnosis with many diseases, said first author Lyen Huang, MD, a research fellow at Stanford University in California. For example, 65.6% of white patients live 5 years after a diagnosis of colorectal cancer, compared with 55.5% of black patients.

"We know that high-volume hospitals are associated with decreased mortality rates after cancer, but minorities are less likely to use these hospitals," Dr Huang said here at the American College of Surgeons 2014 Clinical Congress.

To understand why members of ethnic minorities are less likely to use high-volume hospitals, Dr Huang and his colleagues linked data from the California Cancer Registry with statewide hospital discharge abstracts. They looked for patients treated for colorectal cancer from 1996 to 2006.

The researchers defined high-volume hospitals as those in the top quintile in California for the number of colorectal cancer treatments. They excluded health maintenance organizations because their patients don't have a choice of hospital. Of 79,231 colorectal cancer patients, 44,691 (56%) were treated in high-volume hospitals.

We know that high-volume hospitals are associated with decreased mortality rates after cancer.

The patients traveled a median distance of less than 5.5 miles. The proportion of minorities living this distance from a high-volume hospital, or nearer, was the same or higher than the proportion of white patients.

The odds ratio for black patients using a high-volume hospital, compared with white patients, was 0.65; for Hispanic patients it was 0.60, and for Asian and Pacific Islander patients it was 0.82 (< .001).

The researchers looked at insurance type, but this accounted for only 4% to 6% of the difference. Poverty, employment, and college education accounted for 15% to 17%.

"We believe our finding has identified an important characteristic that can be used to identify communities that are at risk for underutilization of high-volume hospitals," said Dr Huang.

Community Outreach, Referrals

To address the problem, he called for community outreach efforts, changes in referral practices, and partnerships between high-volume and low-volume hospitals.

Social networks could also play a role in patients' choice of hospital, said study discussant Samuel Finlayson, MD, from the University of Utah in Salt Lake City. "Folks may be going to hospitals because their friends go to those hospitals," he said.

Dr Finlayson also suggested that the lower-volume hospitals should improve the quality of care they provide.

After the presentation, an audience member asked how the data would change if health maintenance organizations were included in the analysis. Dr Huang said a publication by his team on that subject is forthcoming.

Another audience member pointed out that the gap in survival rates for prostate cancer between white and ethnic minority patients has narrowed over time. He spoke of an outreach effort targeted at churches, and suggested that such a campaign might have lessons for colorectal cancer.

Dr Huang said he agrees.

Dr Huang and Dr Finlayson have disclosed no relevant financial relationships.

American College of Surgeons (ACS) 2014 Clinical Congress. Presented October 30, 2014.


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