Disparities in Colorectal Cancer Treatment Delay Within Appalachia—The Role of For‐Profit Hospitals

Abstract

Background Appalachian residents have a higher overall cancer burden than the rest of the United States because of the unique features of the region. Treatment delays vary widely within Appalachia, with colorectal cancer patients undergoing median treatment delays of 5 days in Kentucky compared to 9 days for patients in Pennsylvania, Ohio, and North Carolina combined. Objective This study identified the source of this disparity in treatment delay using statistical decomposition techniques. Methodology This study used linked 2006 to 2008 cancer registry and Medicare claims data for the Appalachian counties of Kentucky, Pennsylvania, Ohio, and North Carolina to estimate a 2-part model of treatment delay. An Oaxaca Decomposition of the 2-part model revealed the contribution of the individual determinants to the disparity in delay between Kentucky counties and the remaining 3 states. Results The Oaxaca Decomposition revealed that the higher percentage of patients treated at for-profit facilities in Kentucky proved the key contributor to the observed disparity. In Kentucky, 22.3% patients began their treatment at a for-profit facility compared to 1.4% in the remaining states. Patients initiating treatment at for-profit facilities explained 79% of the observed difference in immediate treatment (<2 days after diagnosis) and 72% of Kentucky’s advantage in log days to treatment. Conclusions The unique role of for-profit facilities led to reduced treatment delay for colorectal cancer patients in Kentucky. However, it remains unknown whether for-profit-hospitals’ more rapid treatment converts to better health outcomes for colorectal cancer patients.

A Social-Ecological Review of Cancer Disparities in Kentucky

“…27–29 In addition, patients have reported delays in treatment, which leads to them being less likely to seek treatment. 30…”

Fatores sociodemográficos e clínicos associados ao tempo para o início do tratamento de câncer de cólon e reto no Brasil, 2006-2015

“…Saúde Pública 2021; 37(5):e00214919 cionais encontraram associação entre o tempo de espera para o tratamento e regiões específicas. O tempo de espera é mais curto em regiões urbanas 32 , com concentração de instituições privadas 33,34 , e em regiões com populações sem privação econômica 35 .…”

The Breast‐Imaging Operations, Practices and Systems Inventory: A framework to examine mammography facility effects on screening in rural communities

“…Ownership status (eg, for-profit, non-profit, or public/government ownership) has been studied in relation to financial and operational performance, finding that for-profit organizations produce comparatively better outcomes and are more efficient. [22][23][24][25] Screening facility resources, which have been linked to outcomes, such as uptake and screening volume, include the number of machines in operation, as well as the technologists and radiologists on staff to care for clients. 17,[26][27][28] For operational factors, range of services, policies, and professional and technical expertise have been found to explain some of the facility variation in access, wait times, and quality.…”