Published online September 28, 2009
PEDIATRICS Vol. 124 No. 4 October 2009, pp. e688-e696 (doi:10.1542/peds.2009-0377)
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ARTICLE

Disparities in Access to Pediatric Neurooncological Surgery in the United States

Debraj Mukherjee, MD, MPHa, Thomas Kosztowski, BSa, Hasan A. Zaidi, BSa, George Jallo, MDa, Benjamin S. Carson, MDa, David C. Chang, PhD, MPH, MBAb,c and Alfredo Quiñones-Hinojosa, MDa

Departments of a Neurosurgery
b Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
c Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

OBJECTIVE: The objective of this study was to investigate whether disparities in access to high-volume centers for neurooncological care existed in the United States in 1988–2005.

METHODS: A retrospective analysis of the Nationwide Inpatient Sample (1988–2005) was performed, with additional factors incorporated from the Area Resource File (2006). International Classification of Diseases, Ninth Revision, diagnosis/procedure coding was used to identify patients. High-volume centers were defined as those with ≥50 neurosurgical cases per year. Patients >18 years of age were excluded. Covariates included age, gender, race, Charlson Index score, insurance, and county-level characteristics (including median home value, proportion of foreign born residents, and county neurosurgeon density). Multivariate analysis was performed by using multiple logistic regression models. P values of <.05 were considered statistically significant.

RESULTS: A total of 4421 patients were identified; 1651 (37.34%) were admitted to high-volume centers. Overall access to high-volume centers improved slightly over the 18-year period (odds ratio [OR]: 1.04). Factors associated with greater access to high-volume centers included greater county neurosurgeon density (OR: 1.72) and greater county home value (OR: 1.66). Factors associated with worse access included Hispanic ethnicity (OR: 0.68) and each 1% increase in foreign residents per county (OR: 0.59). All reported P values were <.05.

CONCLUSION: This study demonstrates that racial and socioeconomic disparities in access to high-volume neurooncological care exist for the pediatric population. We also identify numerous prehospital factors that potentially contribute to persistent disparities and may be amenable to change through national health policy interventions.

Key Words: pediatric • neurooncology • access • disparities • brain tumors

Abbreviations: ARF—Area Resource File • OR—odds ratio • ICD-9—International Classification of Diseases, Ninth Revision • NIS—Nationwide Inpatient Sample • CI—confidence interval

Accepted May 29, 2009.


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