Racial Differences in Surgeons and Hospitals for Endometrial Cancer Treatment

PURPOSE: To determine whether (1) black and white women with endometrial cancer were treated by different surgical specialties and in different types of hospitals and (2) differences in specialty and hospital type contributed to racial differences in survival. METHODS: Retrospective cohort study of 12,307 women aged 65 years and older who underwent surgical treatment of endometrial cancer between 1991 and 1999 in the 11 Surveillance Epidemiology and End Results registries. RESULTS: Black women were more likely to have a gynecologic oncologist to perform their surgery and to be treated at hospitals that were higher volume, larger, teaching, National Cancer Institute centers, urban, and where a greater proportion of the surgeries were performed by a gynecologic oncologist. In unadjusted models, black women were over twice as likely as white women who died because of cancer (hazards ratio [HR]: 2.33), but nearly all of the initial racial difference in survival was explained by differences in cancer stage, and grade as well as age and comorbidities at presentation (adjusted HR: 1.10). Surgical specialty was not associated with survival and, of the hospital characteristics studied, only surgical volume was associated with survival (P < 0.005). Adjusting for hospital characteristics did not change the racial difference in survival (HR: 1.10). Adjustment for the specific hospital where the woman was treated eliminated the association between race and surgeon specialty and slightly widened the residual racial difference in survival (HR: 1.23 vs. 1.10). CONCLUSIONS: In contrast to several studies suggesting that blacks with breast cancer, colon cancer, or cardiovascular disease are treated in hospitals with lower quality indicators, black women diagnosed with endometrial cancer in Surveillance Epidemiology and End Results regions between 1991 and 1999 were more likely to be treated by physicians with advanced training and in high volume, large, urban, teaching hospitals. However, except for a modest association with hospital surgical volume, these provider and hospital characteristics were largely unrelated to survival for women with endometrial cancer. The great majority of the difference in survival was explained by differences in tumor and clinical characteristics at presentation

Cancer · Endometrial cancer · Family medicine · Gynecology · MEDLINE · Political science · Endometrial and Cervical Cancer Treatments · Gynecological conditions and treatments · Internal Medicine · Medicine · Menopause: Health Impacts and Treatments · Oncology

• Racial Disparities in Changing to a High-volume Urologist Among Men With Localized Prostate Cancer

  Craig Evan Pollack, Justin E Bekelman et al.•Medical Care•2011

  Incluir item

• The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catheterization

  Kevin A Schulman, Jesse A Berlin et al.•New England Journal of Medicine•1999

  Incluir item

• Racial residential segregation

  Open Access•David R Williams, Chiquita Collins•Public Health Reports•2001

  Incluir item

• Racial Differences in Definitive Breast Cancer Therapy in Older Women

  Nancy L Keating, Elena Kouri et al.•Medical Care•2009

  Incluir item

• Comorbidity Measures for Use with Administrative Data

  Anne Elixhauser, Claudia Steiner et al.•Medical Care•1998

  Incluir item