Abstract
Objective
The study objective was to understand the impact of race/ethnicity on access to thoracic
surgical care for patients undergoing lung resection for cancer.
Methods
We performed a retrospective analysis on 206 consecutive patients who underwent lung
resection for cancer (120 female, 86 male; median age 66 years), with respect to how
race and ethnicity impact time to referral for thoracic surgery to a major healthcare
center. Time between initial radiographic appearance of a lung nodule/mass 1 cm or
greater to surgical referral and time from surgical referral to operation were evaluated
for 121 White, 30 Asian, 26 Hispanic, 12 African American, and 17 mixed or other race
patients. The impact of age, sex, median income of patient's household, national and
state Area Deprivation Indices, insurance type, and distance between the patient's
domicile and our hospital was evaluated. The influence of the referring physician's
practice (hospital-based, hospital-affiliated, or private), internal or external referral,
race/ethnicity, and level of specialization was also studied.
Results
African American, Asian, Hispanic, and mixed/other race patients had significantly
longer wait times between initial radiographic finding of a lung nodule/mass 1 cm
or greater and surgical referral compared with White individuals (median days: African
American, 78; Asian, 95; Hispanic, 92; mixed or other, 65; White, 35). Multiple linear
regression analysis demonstrated that race/ethnicity was the only significant predictor
of prolonged time to surgical referral when adjusted for age, sex, median household
income level, national and state Area Deprivation Indices, insurance type, and distance
between patient's home and our hospital. The referring physician's type of practice
and internal versus external referral were not significant. However, the physician's
race/ethnicity and level of specialization had an impact on referral times, with nonspecialists
referring patients sooner to thoracic surgery compared with specialists who ordered
more workup tests. For all patient races/ethnicities, there was no difference in time
between surgical referral and day of operation.
Conclusions
Race and ethnicity have a major impact on the time from initial radiographic appearance
of a lung nodule/mass 1 cm or greater to referral for surgical resection for cancer.
This study suggests the need to develop strategies to reduce minority wait times and
improve timely access to surgery for patients with thoracic malignancies.
Video Abstract
(mp4,
(2.15 MB)
Graphical abstract
Graphical Abstract
Key Words
Abbreviations and Acronyms:
CT (computed tomography), IQR (interquartile range), ROC (receiver operating characteristic), UCSD (University of California, San Diego)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 07, 2022
Accepted:
May 10,
2022
Received in revised form:
May 4,
2022
Received:
October 8,
2021
Footnotes
Funding: NIH R01HL119543, NIH R01HL132225 to P.A.T.
M.O. and P.A.T. are Western Thoracic Surgical Association Members.
Identification
Copyright
© 2022 by The American Association for Thoracic Surgery
