The Impact of Regionalization of Cystectomy on Racial Disparities in XXXX Care.

@entity1 @entity150
PURPOSE: Regionalization of surgical care has improved the quality of care for @entity1 with @entity150 . We explored whether regionalization has benefited white and black @entity1 equally. MATERIALS AND METHODS: We used a New York State inpatient database to identify all @entity1 who underwent cystectomy for @entity150 from 1997 to 2011. Hospital volume was classified in quintiles based on the number of cystectomies performed in the first 5 years of the study. Logistic regression was done to assess the association between race and low volume/very low volume hospitals. Racial disparities were further characterized using stratification by time and by the racial composition of the @entity1 community. RESULTS: A total of 8,168 @entity1 treated with cystectomy for @entity150 were included in analysis. Compared with white race, black race was associated with a  higher likelihood of low volume/very low volume hospital use (OR 1.59, 95% CI  1.26-2.02). The disparity was most prominent in 2002 to 2006 (OR 2.51, 95% CI 1.64-3.85) but it did not persist in 2007 to 2011 (OR 1.46, 95% CI 0.92-2.32). Black @entity1 living in a black community had the highest likelihood of low volume/very low volume hospitalization during all periods of increased regionalization (2002 to 2006 OR 4.14, 95% CI 1.84-9.34 and 2007 to 2011 OR 2.40, 95% CI 1.07-5.39). CONCLUSIONS: Regionalization of cystectomy transiently worsened the racial disparity in @entity150 care, although the disparity did not persist with time. Specific efforts may be needed to address the consequences of regionalization in particularly vulnerable subpopulations, such as black @entity1 who live in a black community where disparities have persisted.
