The effect of treatment at minority-serving hospitals on outcomes for bladder cancer

OBJECTIVES: Healthcare for racial minorities is densely concentrated at a small subset of hospitals in the United States. Understanding long-term outcomes at these minority-serving hospitals is highly relevant to elucidating the sources of racial disparities in cancer care. We investigated the effect of treatment at a minority-serving hospital on overall survival and receipt of definitive treatment for bladder cancer.

MATERIALS AND METHODS: Using the National Cancer Database, we identified all patients diagnosed with clinically localized, muscle-invasive bladder cancer between 2004 and 2012. We defined "minority-serving hospitals" as institutions in the top decile by proportion of Black and Hispanic patients within this cohort. Univariate and multivariable analyses were performed to assess the sociodemographic, clinical, and hospital-level factors influencing overall survival and receipt of definitive treatment for bladder cancer.

RESULTS: In adjusted analyses, there was no significant difference in overall survival between patients treated at minority-serving hospitals versus those treated at nonminority-serving hospitals (hazard ratio = 0.95, 95% CI: 0.90-1.01). There was also no significance in receipt of definitive treatment between the two hospital types (odds ratio [OR] = 0.85, 95% CI: 0.68-1.06). Black race was independently associated with increased likelihood of mortality (hazard ratio = 1.08, 95% CI: 1.03-1.14) and decreased odds of receiving appropriate definitive treatment (OR = 0.73, 95% CI: 0.66-0.82).

CONCLUSIONS: There was no difference between minority-serving and nonminority-serving hospitals in overall survival or receipt of definitive treatment. Black patients suffered worse survival and were less likely to receive definitive treatment for bladder cancer regardless of the type of hospital in which they were treated.