Session: MP12: Diversity, Equity & Inclusion: Health Equity & Outcomes I
MP12-17: Predicting the Impact of Improving Quality of Care at Minority-Serving Hospitals on National Racial/Ethnic Disparities: Effects on the Definitive Treatment of Breast, Colon, Lung, and Prostate Cancer
Introduction: A large proportion of minorities receive care at a relatively small number of MSHs. Facility-level disparities, namely in access to definitive treatment, between MSHs and non-MSHs likely contribute to national patient-level racial/ethnic disparities. We aim to estimate the effect of eliminating disparities in the rate of delivery of definitive treatment between minority-serving hospitals (MSH) and non-MSHs on national racial/ethnic disparities in breast, colon, lung, and prostate cancer. Methods: We identified patients 40 years old or older in the National Cancer Database from 2004 to 2015 eligible for definitive treatment for breast, colon, prostate, and non-small cell lung cancers (NSCLC). Institutions in the top decile of proportion of minority (Black and Hispanic) patients were defined as MSHs. We estimated the adjusted odds ratio (AOR) of receiving definitive treatment at an MSH using a logistic model for each cancer site. We then used the estimated coefficients to derive the predicted difference in the average probability of getting treated if the quality of MSH increased to the level of a non-MSH. Results: A total of 2,444,623 patients from 1,334 hospitals were included in the study (breast: 1,236,033 (50.6%), colon: 199,179 (8.2%), NSCLC: 257,057 (10.5%), prostate: 752,354 (30.8%)). Overall, 222,770 (9.1%) patients were treated at MSHs while 2,221,853 (90.9%) were treated at non-MSHs. For each cancer, patients treated at MSHs were significantly less likely to undergo definitive therapy (breast: AOR 0.78 (95%CI 0.65-0.94); colon: AOR 0.77 (95%CI 0.65 – 0.91); lung: AOR 0.80 (95%CI 0.68-0.94); prostate: 0.75 (95%CI 0.63-0.90)). If patients at MSHs received definitive treatment at the same rate as patients in non-MSHs, the national probability of minority patients receiving definitive therapy would significantly increase for all cancers (breast: +1.09% (95%CI: 1.08 – 1.10); colon: +4.34% (95%CI: 4.30 – 4.38); lung: +2.41% (95%CI: 2.40 – 2.43); and prostate: +4.25% (95%CI: 4.24 – 4.27)). This represents 5,322 additional minority patients accessing definitive. Conclusions: We found that patients treated at MSH for breast, colon, NSLSC, and prostate cancer are significantly less likely to receive definitive treatment for their treatment-eligible disease compared to patients treated at non-MSHs. Equalizing facility-level access to definitive cancer treatment between MSHs and non-MSHs would reduce patient-level national racial/ethnic disparities. SOURCE OF Funding: -
