Racial/Ethnic Disparities in Use of High-Quality Hospitals Among Oral Cancer Patients in California.

Abstract

To examine racial/ethnic differences in use of high-quality hospitals in patients treated for oral cancer in California. Retrospective cancer database cohort study. Data were extracted from the California Cancer Registry data set linked with discharge records and hospital characteristics from the California Office of Statewide Health Planning and Development, and with neighborhood characteristics from the California Neighborhoods Data System. The study cohort comprised adult patients with oral cavity malignancy diagnosed between 2004 and 2015. Principal component analysis was used to generate the composite oral cancer-specific hospital quality score. The impact of hospital quality on survival was assessed using Cox regression models with robust standard error using sandwich variance estimators. Poisson regression models with robust error variance were used to assess the association between race/ethnicity and use of high-quality hospitals. Patients treated in hospitals ranked in the top quartile for quality had improved overall survival (hazard ratio 0.86, 95% confidence intervals [CI] 0.76-0.98), after adjusting for tumor stage, Charlson comorbidity score, neck dissection, radiotherapy, age, sex, race, and insurance status. Black patients (risk ratio 0.87, 95% CI 0.77-0.98) were less likely to be treated in high-quality hospitals compared with non-Hispanic White patients. Treatment in high-quality hospitals is associated with improved survival for patients with oral cancer. However, black patients are less likely to be treated in high-quality hospitals compared with non-Hispanic white patients. 3 Laryngoscope, 132:793-800, 2022.