Location Isn't Everything: Proximity, Hospital Characteristics, Choice of Hospital, and Disparities for Breast Cancer Surgery Patients

• Published in: Health services research Vol. 51; no. 4; pp. 1561 - 1583
• Main Authors: Keating, Nancy L., Kouri, Elena M., He, Yulei, Freedman, Rachel A., Volya, Rita, Zaslavsky, Alan M.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.08.2016; Health Research and Educational Trust; John Wiley and Sons Inc
• Subjects: African Americans - statistics & numerical data; Aged; Analysis; Asian Americans - statistics & numerical data; Breast; Breast cancer; Breast Neoplasms - ethnology; Breast Neoplasms - surgery; Cancer; Cancer patients; Cancer surgery; Censuses; Characteristics; Choice Behavior; Decision making models; Discrete choice; distance; Ethnicity; European Continental Ancestry Group - statistics & numerical data; Female; Geographic Disparities; Geography, Medical; Government programs; Health aspects; Health care; Health care disparities; Health disparities; Healthcare Disparities - statistics & numerical data; Hispanic Americans - statistics & numerical data; Hospital patients; hospital racial composition; Hospitals; Hospitals - statistics & numerical data; Humans; Latin American cultural groups; Mastectomy; Medicaid; Medical care; Medical care quality; Medicare; Minority & ethnic groups; Minority Groups; Patients; Predictions; Proximity; Quality management; Race; Radiation; Radiation therapy; Radiotherapy; Residence; Residential areas; Residential location; SEER Program; Studies; Surgery; United States; Women; Michigan; United States > US; health care disparities; hospital racial composition; Breast cancer; distance; surgery
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/1475-6773.12443

Objective Assess the relative importance of proximity and other hospital characteristics in the choice of hospital for breast cancer surgery by race/ethnicity. Data SEER‐Medicare data. Study Design Observational study of women aged >65 years receiving surgery for stage I/II/III breast cancer diagnosed in 1992–2007 in Detroit (N = 10,746 white/black), Atlanta (N = 4,018 white/black), Los Angeles (N = 9,433 white/black/Asian/Hispanic), and San Francisco (N = 4,856 white/black/Asian). We calculated the distance from each patient's census tract of residence to each area hospital. We estimated discrete choice models for the probability of receiving surgery at each hospital based on distance and assessed whether deviations from these predictions entailed interactions of hospital characteristics with the patient's race/ethnicity. We identified high‐quality hospitals by rates of adjuvant radiation therapy and by survey measures of patient experiences, and we assessed how observed surgery rates at high‐quality hospitals deviated from those predicted based on distance alone. Principal Findings Proximity was significantly associated with hospital choice in all areas. Minority more often than white breast cancer patients had surgery at hospitals with more minority patients, those treating more Medicaid patients, and in some areas, lower quality hospitals. Conclusions Residential location alone does not explain concentration of racial/ethnic‐minority breast cancer surgery patients in certain hospitals that are sometimes of lower quality.