Tseng Christopher C, Gao Jeff, Barinsky Gregory L, Fang Christina H, Grube Jordon G, Patel Prayag, Hsueh Wayne D, Eloy Jean Anderson
Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine, Bronx, New York, USA.
Otolaryngol Head Neck Surg. 2023 Mar;168(3):413-421. doi: 10.1177/01945998221099819. Epub 2023 Jan 28.
To examine factors associated with hospital safety net burden and its impact on survival for patients with sinonasal squamous cell carcinoma (SNSCC).
Retrospective database study.
National Cancer Database from 2004 to 2016.
SNSCC cases were identified in the National Cancer Database. Hospital safety net burden was defined by percentage of uninsured/Medicaid patients treated, namely ≤25% for low-burden hospitals, 26% to 75% for medium-burden hospitals, and >75% for high-burden hospitals (HBHs). Univariate and multivariate analyses were used to investigate patient demographics, clinical characteristics, and overall survival.
An overall 6556 SNSCC cases were identified, with 1807 (27.6%) patients treated at low-burden hospitals, 3314 (50.5%) at medium-burden hospitals, and 1435 (21.9%) at HBHs. On multivariate analysis, Black race (odds ratio [OR], 1.39; 95% CI, 1.028-1.868), maxillary sinus primary site (OR, 1.31; 95% CI, 1.036-1.643), treatment at an academic/research program (OR, 20.63; 95% CI, 8.868-47.980), and treatment at a higher-volume facility (P < .001) resulted in increased odds of being treated at HBHs. Patients with grade III/IV tumor (OR, 0.70; 95% CI, 0.513-0.949), higher income (P < .05), or treatment modalities other than surgery alone (P < .05) had lower odds. Survival analysis showed that hospital safety net burden status was not significantly associated with overall survival (log-rank P = .727).
In patients with SNSCC, certain clinicopathologic factors, including Black race, lower income, treatment at an academic/research program, and treatment at facilities in the West region, were associated with treatment at HBHs. Hospital safety net burden status was not associated with differences in overall survival.
研究与鼻窦鳞状细胞癌（SNSCC）患者医院安全网负担相关的因素及其对生存的影响。
回顾性数据库研究。
2004年至2016年的国家癌症数据库。
在国家癌症数据库中识别SNSCC病例。医院安全网负担由接受治疗的未参保/医疗补助患者的百分比定义，即低负担医院≤25%，中等负担医院26%至75%，高负担医院（HBHs）>75%。采用单因素和多因素分析来研究患者人口统计学、临床特征和总生存率。
共识别出6556例SNSCC病例，其中1807例（27.6%）患者在低负担医院接受治疗，3314例（50.5%）在中等负担医院接受治疗，1435例（21.9%）在高负担医院接受治疗。多因素分析显示，黑人种族（优势比[OR]，1.39；95%置信区间[CI]，1.028 - 1.868）、上颌窦原发部位（OR，1.31；95% CI，1.036 - 1.643）、在学术/研究项目中接受治疗（OR，20.63；95% CI，8.868 - 47.980）以及在高容量机构接受治疗（P <.001）导致在高负担医院接受治疗的几率增加。III/IV级肿瘤患者（OR，0.70；95% CI，0.513 - 0.949）、收入较高（P <.05）或采用非单纯手术治疗方式（P <.05）的患者几率较低。生存分析表明，医院安全网负担状况与总生存率无显著相关性（对数秩检验P = 0.727）。
在SNSCC患者中，某些临床病理因素，包括黑人种族、低收入、在学术/研究项目中接受治疗以及在西部地区的机构接受治疗，与在高负担医院接受治疗有关。医院安全网负担状况与总生存率差异无关。
