PMID- 33555062
OWN - NLM
STAT- MEDLINE
DCOM- 20210603
LR  - 20210603
IS  - 1531-4995 (Electronic)
IS  - 0023-852X (Linking)
VI  - 131
IP  - 6
DP  - 2021 Jun
TI  - Disparities in Laryngeal Cancer Treatment and Outcomes: An Analysis by Hospital 
      Safety-Net Burden.
PG  - E1987-E1997
LID - 10.1002/lary.29416 [doi]
AB  - OBJECTIVES/HYPOTHESIS: To analyze the impact of hospital safety-net burden on 
      survival outcomes for laryngeal squamous cell carcinoma (LSCC) patients. STUDY 
      DESIGN: Retrospective cohort study. METHODS: From 2004 to 2015, 59,733 LSCC 
      patients treated with curative intent were identified using the National Cancer 
      Database. Low (LBH) <25th, medium (MBH) 25th-75th, and high (HBH) >75th 
      safety-net burden hospitals were defined by the percentage quartiles (%) of 
      uninsured/Medicaid-insured patients treated. Social and clinicopathologic 
      characteristics and overall survival (using Kaplan-Meier survival analysis) were 
      evaluated. Crude and adjusted hazard ratios (HR) with 95% confidence intervals 
      (CI) were computed using Cox regression modeling. RESULTS: There were 324, 647, 
      and 323 hospitals that met the criteria as LBH, MBH, and HBH, respectively. The 
      median follow-up was 38.6 months. A total of 27,629 deaths were reported, with a 
      median survival of 75.8 months (a 5-year survival rate of 56.6%). Median survival 
      was 83.2, 77.8, and 69.3 months for patients from LBH, MBH, and HBH, respectively 
      (P < .0001). The median % of uninsured/Medicaid-insured patients treated among 
      LBH, MBH, and HBH were 3.6%, 14.0%, and 27.0%, respectively. Patients treated at 
      HBH were significantly more likely to be young, Black, Hispanic, of low income, 
      and present with more advanced disease compared to LBH and MBH. Survival was 
      comparable for LBH and MBH (HR = 1.02; 95% CI = 0.97-1.07, P = .408) on 
      multivariate analysis. HBH, compared to LBH patients, had inferior survival (HR = 
      1.07; 95% CI = 1.01-1.13, P = .023). CONCLUSIONS: High burden safety-net 
      hospitals receive disproportionately more patients with advanced-stage and low 
      socioeconomic status, yielding inferior survival compared to low burden 
      hospitals. LEVEL OF EVIDENCE: 3 (individual cohort study) Laryngoscope, 
      131:E1987-E1997, 2021.
CI  - (c) 2021 The American Laryngological, Rhinological and Otological Society, Inc.
FAU - Qureshi, Muhammad M
AU  - Qureshi MM
AD  - Department of Radiation Oncology, Boston Medical Center, Boston University School 
      of Medicine, Boston, Massachusetts, U.S.A.
FAU - Oladeru, Oluwadamilola T
AU  - Oladeru OT
AD  - Harvard Radiation Oncology Program, Massachusetts General Hospital, Boston, 
      Massachusetts, U.S.A.
FAU - Lam, Christa M
AU  - Lam CM
AD  - Department of Radiation Oncology, Boston Medical Center, Boston University School 
      of Medicine, Boston, Massachusetts, U.S.A.
FAU - Dyer, Michael A
AU  - Dyer MA
AD  - Department of Radiation Oncology, Boston Medical Center, Boston University School 
      of Medicine, Boston, Massachusetts, U.S.A.
FAU - Mak, Kimberley S
AU  - Mak KS
AD  - Department of Radiation Oncology, Boston Medical Center, Boston University School 
      of Medicine, Boston, Massachusetts, U.S.A.
FAU - Hirsch, Ariel E
AU  - Hirsch AE
AD  - Department of Radiation Oncology, Boston Medical Center, Boston University School 
      of Medicine, Boston, Massachusetts, U.S.A.
FAU - Truong, Minh Tam
AU  - Truong MT
AUID- ORCID: 0000-0001-6662-4981
AD  - Department of Radiation Oncology, Boston Medical Center, Boston University School 
      of Medicine, Boston, Massachusetts, U.S.A.
LA  - eng
PT  - Journal Article
DEP - 20210208
PL  - United States
TA  - Laryngoscope
JT  - The Laryngoscope
JID - 8607378
SB  - IM
MH  - Aged
MH  - Carcinoma, Squamous Cell/*mortality/*therapy
MH  - Female
MH  - *Healthcare Disparities
MH  - Humans
MH  - Laryngeal Neoplasms/*mortality/*therapy
MH  - Male
MH  - Middle Aged
MH  - Practice Patterns, Physicians'/*statistics & numerical data
MH  - Retrospective Studies
MH  - *Safety-net Providers
MH  - Survival Rate
MH  - United States/epidemiology
OTO - NOTNLM
OT  - Laryngeal cancer
OT  - race
OT  - safety-net
OT  - survival analysis
OT  - vulnerable population
EDAT- 2021/02/09 06:00
MHDA- 2021/06/04 06:00
CRDT- 2021/02/08 08:47
PHST- 2020/12/28 00:00 [revised]
PHST- 2020/06/03 00:00 [received]
PHST- 2021/01/10 00:00 [accepted]
PHST- 2021/02/09 06:00 [pubmed]
PHST- 2021/06/04 06:00 [medline]
PHST- 2021/02/08 08:47 [entrez]
AID - 10.1002/lary.29416 [doi]
PST - ppublish
SO  - Laryngoscope. 2021 Jun;131(6):E1987-E1997. doi: 10.1002/lary.29416. Epub 2021 Feb 
      8.