Utilization of subspecialty care by Hispanic pediatric oncology patients, California 1983-2010.

Abstract

e17504 Background: Previous analysis has shown that Hispanic pediatric oncology patients in California have decreased utilization of pediatric cancer specialty centers (PCSC). The purpose of this study was to examine the clinical and non-clinical factors associated with decreased inpatient utilization of PCSCs by Hispanic pediatric oncology patients. Methods: Using the California Office of Statewide Health Planning and Development private database we performed a retrospective population based analysis of Hispanic patient discharges 0-18 years of age to explore the influence of age, gender, payer, income, distance to admission site, tumor type and diagnosis of fever and neutropenia on the utilization of PCSCs by Hispanic patients. Results: Analysis of 82,832 Hispanic pediatric oncology discharges showed concentration of hospitalization in PCSCs increasing from 64% in 1983 to 94% in 2010. In addition, an increased percentage of acute lymphoblastic leukemia discharges was seen for Hispanics (28.3%) compared to all discharges (22.4%). The adjusted regression analysis revealed decreased utilization of PCSCs for patients ages 15-18 (OR 0.466; CI 0.441-0.493) and for those residing 6 - 10 miles from a PCSC (OR 0.927; CI 0.883 - 0.974). Increased utilization of PCSCs was seen for Hispanic patients living in zip codes where household income was >4 times the Federal Poverty Level. Payer status was not significantly associated with discharge from a PCSC. None of these findings changed when Los Angeles County was removed from the analysis. A separate analysis was done on Hispanic pediatric oncology patients with a discharge diagnosis of fever and neutropenia. For this subset decreased utilization was seen for those with private insurance (OR 0.84; CI 0.81-0.887), age <1 (OR 0.719; CI 0.64-0.808), ages 15-18 (OR 0.596; CI 0.558-0.636) and those residing >40 miles from a PCSC (OR 0.913; CI 0.854-0.975). Conclusions: Utilization of inpatient pediatric oncology care by Hispanic patients in California has become regionalized in PCSCs since 1983 and is influenced by age, and geography, with payer status not being a significant contributor. Clinical outcomes as they relate to access to PCSCs for Hispanic patients should be examined.