ArticleBMJ open2014
Disparities in selective referral for cancer surgeries: implications for the current healthcare delivery system.
Article in BMJ open, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 46 citations in OpenAlex.
- Disparities in Surgical Access: A Systematic Literature Review, Conceptual Model, and Evidence Map.Journal of the American College of Surgeons · 2019Pooled it
- Does Race Influence Risk Assessment and Recommendations for Lung Resection? A Randomized Trial.The Annals of thoracic surgery · 2018Trial
- Association of race and 30-day postoperative complications after urologic oncology surgery.Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2025Article
- Racial disparities in pediatric spinal fusion surgery affect perioperative outcomes: a national multicenter study.Spine deformity · 2025Article
- Health Disparities among Patients with Cancer Who Received Molecular Testing for Biomarker-Directed Therapy.Cancer research communications · 2024Article
- Overall Volume of Upper Gastrointestinal Surgery Positively Impacts Gastric Cancer Outcomes at Centers with Low Gastrectomy Volume.Annals of surgical oncology · 2024Article
- A nationwide analysis of disparities in guideline-concordant care in American Indians and Alaska Natives with stage I non-small cell lung cancer.Journal of thoracic disease · 2023Article
- Anabolic and Antiresorptive Osteoporosis Treatment: Trends, Costs, and Sequence in a Commercially Insured Population, 2003-2021.JBMR plus · 2023Article
- Assessing racial residential segregation as a risk factor for severe maternal morbidity.Annals of epidemiology · 2023Article
- Racial disparities in minimally invasive esophagectomy and gastrectomy for upper GI malignancies.Surgical endoscopy · 2022Article
- Leveraging genomic diversity for discovery in an electronic health record linked biobank: the UCLA ATLAS Community Health Initiative.Genome medicine · 2022Article
- Is perfect the enemy of good? Weighing the evidence for biparametric MRI in prostate cancer.The British journal of radiology · 2022Review
- A narrative review of socioeconomic disparities in the treatment of esophageal cancer.Journal of thoracic disease · 2021Review
- Perioperative complications and oncological outcomes following radical cystectomy among different racial groups: A long-term, single-center study.Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2020Article
- Association Between Marital Status and Racial Disparities in Esophageal Cancer Care.JCO oncology practice · 2020Article
- Effect of academic status on outcomes of surgery for rectal cancer.Surgical endoscopy · 2018Article
- Esophageal surgery in Italy. Criteria to identify the hospital units and the tertiary referral centers entitled to perform it.Updates in surgery · 2016Review
- Nonclinical Factors Associated with 30-Day Mortality after Lung Cancer Resection: An Analysis of 215,000 Patients Using the National Cancer Data Base.Journal of the American College of Surgeons · 2015Article
- Article
- Frequency of Surgery in Black Patients with Malignant Pleural Mesothelioma.Disease markers · 2015Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesAmong considerable efforts to improve quality of surgical care, expedited measures such as a selective referral to high-volume institutions have been advocated. Our objective was to examine whether racial, insurance and/or socioeconomic disparities exist in the use of high-volume hospitals for complex surgical oncological procedures within the USA. DESIGN, SETTING AND
participantsPatients undergoing colectomy, cystectomy, oesophagectomy, gastrectomy, hysterectomy, lung resection, pancreatectomy or prostatectomy were identified retrospectively, using the Nationwide Inpatient Sample, between years 1999 and 2009. This resulted in a weighted estimate of 2 508 916 patients. PRIMARY OUTCOME MEASURES: Distribution of patients according to race, insurance and income characteristics was examined according to low-volume and high-volume hospitals (highest 20% of patients according to the procedure-specific mean annual volume). Generalised linear regression models for prediction of access to high-volume hospitals were performed.
resultsInsurance providers and county income levels varied differently according to patients' race. Most Caucasians resided in wealthier counties, regardless of insurance types (private/Medicare), while most African Americans resided in less wealthy counties (≤$24 999), despite being privately insured. In general, Caucasians, privately insured, and those residing in wealthier counties (≥$45 000) were more likely to receive surgery at high-volume hospitals, even after adjustment for all other patient-specific characteristics. Depending on the procedure, some disparities were more prominent, but the overall trend suggests a collinear effect for race, insurance type and county income levels.
conclusionsPrevailing disparities exist according to several patient and sociodemographic characteristics for utilisation of high-volume hospitals. Efforts should be made to directly reduce such disparities and ensure equal healthcare delivery.
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