Low Hospital Volume Is Associated with Higher All-Cause Mortality in Black Women with Triple Negative Breast Cancer.

IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Samilia Obeng-Gyasi, Demond Handley, Mohamed I Elsaid, Saurabh Rahurkar, Barbara L Andersen, Pallavi Jonnalagadda, J C Chen, Nicci Owusu-Brackett, William E Carson, Daniel G Stover
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Abstract

Introduction: This study examines the association between hospital volume and all-cause mortality in Black women with triple negative breast cancer (TNBC) who received surgery and chemotherapy.

Methods: Black women ages 18+ with stage I-III TNBC who received both surgery and chemotherapy were identified in the National Cancer Database (NCDB). Hospital volume was determined using the number of annual breast cancer cases divided by the number of years the hospital participated in the NCDB. Hospital annual volume quartiles ranged from Q1 (lowest) to Q4 (highest). Univariable analysis and multivariable logistic regression modeling with restricted cubic splines examined the effect of hospital volume on all-cause mortality.

Results: Sixteen thousand five hundred fifty-six patients met the study criteria. All-cause mortality incidence was lower at higher volume compared to lower volume hospitals Q1 24.1% (95% CI: 22.8 to 25.4), Q2 21.8% (95% CI: 20.5 to 23.1), Q3 20.9% (95% CI: 19.6 to 22.1), Q4 19.0% (95% CI: 17.7 to 20.1), p<0.001. On multivariable analysis, treatment at the highest hospital volume quartile was associated with a 21% reduction in the odds of death compared to the lowest quartile [Q4 Vs. Q1, OR=0.79 (95% CI: 0.67 to 0.92)]. For every 100-patient increase in annual volume, all-cause mortality was reduced by 4% [OR=0.96 (95% CI: 0.94 to 0.98)]. There was a significant linear dose-dependent relationship between increasing hospital volume and all-cause mortality.

Conclusion: Black women treated at high-volume hospitals have lower all-cause mortality than those at low-volume hospitals. Future studies should examine the characteristics of high-volume hospitals associated with improved outcomes.

Abstract Image

低医院容量与黑人女性三阴性乳腺癌患者较高的全因死亡率相关
本研究探讨了接受手术和化疗的黑人三阴性乳腺癌(TNBC)患者的医院容量与全因死亡率之间的关系。方法:在国家癌症数据库(NCDB)中确定年龄18岁以上的I-III期TNBC黑人女性,她们接受了手术和化疗。医院数量是用每年乳腺癌病例数除以医院参与国家乳腺癌数据库的年数来确定的。医院年业务量四分位数从第一季度(最低)到第四季度(最高)不等。单变量分析和限制三次样条的多变量logistic回归模型检验了医院容量对全因死亡率的影响。结果:一万六千五百五十六例患者符合研究标准。与低容量医院相比,高容量医院的全因死亡率发病率较低,Q1为24.1% (95% CI: 22.8 ~ 25.4), Q2为21.8% (95% CI: 20.5 ~ 23.1), Q3为20.9% (95% CI: 19.6 ~ 22.1), Q4为19.0% (95% CI: 17.7 ~ 20.1), p4 vs Q1, OR=0.79 (95% CI: 0.67 ~ 0.92)。年容量每增加100例患者,全因死亡率降低4% [OR=0.96 (95% CI: 0.94 ~ 0.98)]。医院容量增加与全因死亡率之间存在显著的线性剂量依赖关系。结论:黑人妇女在大医院治疗的全因死亡率低于小医院。未来的研究应检查与改善预后相关的大容量医院的特点。
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来源期刊
Journal of Racial and Ethnic Health Disparities
Journal of Racial and Ethnic Health Disparities PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
7.30
自引率
5.10%
发文量
263
期刊介绍: Journal of Racial and Ethnic Health Disparities reports on the scholarly progress of work to understand, address, and ultimately eliminate health disparities based on race and ethnicity. Efforts to explore underlying causes of health disparities and to describe interventions that have been undertaken to address racial and ethnic health disparities are featured. Promising studies that are ongoing or studies that have longer term data are welcome, as are studies that serve as lessons for best practices in eliminating health disparities. Original research, systematic reviews, and commentaries presenting the state-of-the-art thinking on problems centered on health disparities will be considered for publication. We particularly encourage review articles that generate innovative and testable ideas, and constructive discussions and/or critiques of health disparities.Because the Journal of Racial and Ethnic Health Disparities receives a large number of submissions, about 30% of submissions to the Journal are sent out for full peer review.
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