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Am J Public Health. 2014 Sep;104 Suppl 4:S562-71. doi: 10.2105/AJPH.2014.302079.

Racial disparities in cancer care in the Veterans Affairs health care system and the role of site of care.

Author information

1
Cleo A. Samuel, Mary Beth Landrum, Barbara J. McNeil, and Nancy L. Keating are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Samuel R. Bozeman is with Abt Associates, Cambridge, MA. Christina D. Williams is with the Division of Hematology-Oncology, Durham Veterans Affairs Medical Center, Durham, NC.

Abstract

OBJECTIVES:

We assessed cancer care disparities within the Veterans Affairs (VA) health care system and whether between-hospital differences explained disparities.

METHODS:

We linked VA cancer registry data with VA and Medicare administrative data and examined 20 cancer-related quality measures among Black and White veterans diagnosed with colorectal (n = 12,897), lung (n = 25,608), or prostate (n = 38,202) cancer from 2001 to 2004. We used logistic regression to assess racial disparities for each measure and hospital fixed-effects models to determine whether disparities were attributable to between- or within-hospital differences.

RESULTS:

Compared with Whites, Blacks had lower rates of early-stage colon cancer diagnosis (adjusted odds ratio [AOR] = 0.80; 95% confidence interval [CI] = 0.72, 0.90), curative surgery for stage I, II, or III rectal cancer (AOR = 0.57; 95% CI = 0.41, 0.78), 3-year survival for colon cancer (AOR = 0.75; 95% CI = 0.62, 0.89) and rectal cancer (AOR = 0.61; 95% CI = 0.42, 0.87), curative surgery for early-stage lung cancer (AOR = 0.50; 95% CI = 0.41, 0.60), 3-dimensional conformal or intensity-modulated radiation (3-D CRT/IMRT; AOR = 0.53; 95% CI = 0.47, 0.59), and potent antiemetics for highly emetogenic chemotherapy (AOR = 0.87; 95% CI = 0.78, 0.98). Adjustment for hospital fixed-effects minimally influenced racial gaps except for 3-D CRT/IMRT (AOR = 0.75; 95% CI = 0.65, 0.87) and potent antiemetics (AOR = 0.95; 95% CI = 0.82, 1.10).

CONCLUSIONS:

Disparities in VA cancer care were observed for 7 of 20 measures and were primarily attributable to within-hospital differences.

PMID:
25100422
PMCID:
PMC4151900
DOI:
10.2105/AJPH.2014.302079
[Indexed for MEDLINE]
Free PMC Article

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