Racial Composition of Hospitals: Effects on Surgery for Early-Stage Non–Small-Cell Lung Cancer

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Abstract
Purpose: Black patients undergo potentially curative surgery for early-stage lung cancer at a lower rate when compared with white patients. Our study examines the relationship between the percentage of black patients treated at a hospital to determine whether it affects the likelihood of obtaining cancer-directed surgery for patients with non–small-cell lung cancer (NSCLC). Patients and Methods: We examined claims data of Medicare-eligible patients with nonmetastatic NSCLC living in areas monitored by the Surveillance, Epidemiology, and End Results program between 1991 and 2001. Hospitals were categorized by the percentage of black patients seen: ≤ 8%, more than 8% to 29%, and ≥ 30%. Logistic regression with clustering analysis was used to calculate the odds of undergoing surgical resection. Results: Among 9,688 patients with NSCLC, 59% of white patients were seen at a hospital that had ≤ 8% black patients, whereas 60% of black patients were seen in hospitals that had ≥ 30% black patients. Regression analysis revealed that hospital racial composition of 30% or greater black patients had a significant negative effect on the likelihood of undergoing surgery for all patients (odds ratio [OR] = 0.71; 95% CI, 0.57 to 0.87), with black race (OR = 0.69; 95% CI, 0.56 to 0.85) and being seen at a low-volume hospital (OR = 0.64; 95% CI, 0.0.49 to 0.83) having a significant negative impact on likelihood of undergoing surgery. Conclusion: Our study results indicate that patient and hospital characteristics are significant predictors of undergoing surgery for Medicare beneficiaries with localized lung cancer. Further examination of the role of the patient-, provider-, and hospital-level factors, in association with the decision to pursue surgical treatment of localized lung cancers, is needed.