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高危癌症手术患者获得高容量医院服务的机会:种族和少数民族群体视角。

Access to High-Volume Hospitals for High-Risk Cancer Surgery for Racial and Ethnic Minoritized Groups.

机构信息

Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.

National Clinician Scholars Program, Yale University School of Medicine, New Haven, CT, USA.

出版信息

JNCI Cancer Spectr. 2022 Mar 2;6(2). doi: 10.1093/jncics/pkac024.

Abstract

High-volume hospitals have been associated with better outcomes for high-risk cancer surgeries, although concerns exist concerning inequitable access to these high-volume hospitals. We assessed tendencies in access to high-volume hospitals for 4 (lung, pancreatic, rectal, esophageal) high-risk cancer surgeries for Black and Hispanic patients in the National Cancer Database. Hospitals were classified as high volume according to Leapfrog Group volume thresholds. Odds of accessing high-volume hospitals increased over time for Black and Hispanic patients for 3 surgeries, but Black patients had lower probabilities of undergoing a pancreatectomy, proctectomy, or esophagectomy at high-volume hospitals than non-Black patients (eg, 2016 pancreatectomy rate: 49.0% [95% confidence interval (CI) = 45.4% to 52.5%] vs 62.3% [95% CI = 61.1% to 63.5%]). Although for Hispanics the gap narrowed for lung resection and pancreatectomy, these populations continued to have lower probabilities of accessing high-volume hospitals than non-Hispanic patients (eg, 2016 pancreatectomy: 48.8% [95% CI = 44.1% to 53.5%] vs 61.6% [95% CI = 60.5% to 62.8%]). Despite increased access to high-volume hospitals for high-risk cancer surgeries, ongoing efforts to improve equity in access are needed.

摘要

高容量医院与高危癌症手术的更好结果相关,但人们对这些高容量医院的公平获取存在担忧。我们评估了国家癌症数据库中 4 种(肺、胰腺、直肠、食管)高危癌症手术中黑人和西班牙裔患者获取高容量医院的趋势。根据 Leapfrog Group 的容量阈值,医院被分类为高容量。对于 3 种手术,黑人和西班牙裔患者获取高容量医院的机会随着时间的推移而增加,但黑人患者在高容量医院接受胰腺切除术、直肠切除术或食管切除术的概率低于非黑人患者(例如,2016 年胰腺切除术率:49.0%[95%置信区间(CI)=45.4%至 52.5%]与 62.3%[95% CI=61.1%至 63.5%])。尽管对于肺切除术和胰腺切除术,西班牙裔的差距缩小了,但这些人群在获取高容量医院方面的机会仍然低于非西班牙裔患者(例如,2016 年胰腺切除术:48.8%[95% CI=44.1%至 53.5%]与 61.6%[95% CI=60.5%至 62.8%])。尽管高危癌症手术获取高容量医院的机会增加,但仍需要努力改善公平获取的机会。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf6c/8997114/5b331443fd12/pkac024f1.jpg

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