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J Rural Health. 2015 Fall;31(4):382-91. doi: 10.1111/jrh.12122. Epub 2015 May 29.

Disparities in Colorectal Cancer Treatment Delay Within Appalachia--The Role of For-Profit Hospitals.

Author information

1
Division of Health Services Management and Policy, College of Public Health, Ohio State University, Columbus, Ohio.
2
Department of Public Health Science, College of Medicine, University of Virginia, Charlottesville, Virginia.
3
Department of Community Health Sciences, Peshawar Medical College, Riphah International University, Peshawar, Pakistan.
4
Department of Epidemiology, University of Kentucky, Lexington, Kentucky.

Abstract

BACKGROUND:

Appalachian residents have a higher overall cancer burden than the rest of the United States because of the unique features of the region. Treatment delays vary widely within Appalachia, with colorectal cancer patients undergoing median treatment delays of 5 days in Kentucky compared to 9 days for patients in Pennsylvania, Ohio, and North Carolina combined.

OBJECTIVE:

This study identified the source of this disparity in treatment delay using statistical decomposition techniques.

METHODOLOGY:

This study used linked 2006 to 2008 cancer registry and Medicare claims data for the Appalachian counties of Kentucky, Pennsylvania, Ohio, and North Carolina to estimate a 2-part model of treatment delay. An Oaxaca Decomposition of the 2-part model revealed the contribution of the individual determinants to the disparity in delay between Kentucky counties and the remaining 3 states.

RESULTS:

The Oaxaca Decomposition revealed that the higher percentage of patients treated at for-profit facilities in Kentucky proved the key contributor to the observed disparity. In Kentucky, 22.3% patients began their treatment at a for-profit facility compared to 1.4% in the remaining states. Patients initiating treatment at for-profit facilities explained 79% of the observed difference in immediate treatment (<2 days after diagnosis) and 72% of Kentucky's advantage in log days to treatment.

CONCLUSIONS:

The unique role of for-profit facilities led to reduced treatment delay for colorectal cancer patients in Kentucky. However, it remains unknown whether for-profit hospitals' more rapid treatment converts to better health outcomes for colorectal cancer patients.

KEYWORDS:

Appalachia; colorectal cancer; decomposition analysis; disparities

PMID:
26032695
PMCID:
PMC4592384
DOI:
10.1111/jrh.12122
[Indexed for MEDLINE]
Free PMC Article

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