Differences in Physician Referral Drive Disparities in Surgical Intervention for XXXX : A Retrospective Cohort Study.

@entity1 @entity157 @entity5
OBJECTIVE: To determine whether sociodemographic and geographic factors are associated with referral for surgery and receipt of recommended surgical intervention. BACKGROUND: Surgical interventions confer survival advantages compared with palliative therapies for @entity157 ( @entity157 ), but disparities exist in use of surgical intervention. Few have investigated referral for surgery as a potential barrier to surgical intervention, and little is known about the effects of @entity1 geographic factors, including proximity to surgical centers. METHODS: Data were abstracted from the @entity5 Registry for @entity1 with a diagnosis of @entity157 from 2006 to 2011. Using hospital procedure volume data from the Pennsylvania Health Care Cost Containment Council, we calculated proximity to a surgical center. We used multivariable logistic regression to determine whether geographic, racial, socioeconomic, and clinical factors were associated with referral for surgery and receipt of a recommended surgical intervention. RESULTS: Of 3576 @entity1 with @entity157 , 41.0% were referred for surgery. @entity1 who lived closer to a surgical center were less likely to be referred for surgery (adjusted odds ratio=0.79; 95% confidence interval, 0.68-0.92). Surgical referral was less likely among older, male @entity1 with Medicaid insurance and advanced @entity5 stage at diagnosis. Of those referred, 1276 (87.0%) underwent surgical intervention. Proximity to a surgical center was not associated with receipt of surgical intervention (P=0.27). @entity1 with distant @entity5 stage at diagnosis were less likely to receive recommended surgical intervention (adjusted odds ratio=0.27; 95% confidence interval, 0.15-0.50). CONCLUSIONS: Geographic and sociodemographic disparities in referral for surgery may be major barriers to surgical intervention for @entity1 with @entity157 .
