Research theme
Place and vulnerability
How neighborhood, rurality and historic policy shape access to high-quality cancer care.
62 articles, newest first
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Rural Residence and Postsurgical Outcomes Among Medicare Beneficiaries
Among Medicare patients having common general surgery operations, living in a rural area was associated with higher rates of death, complications and readmission and a lower chance of being discharged home.
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Distribution of pancreatic cancer surgery centers and spatial access to care
In the United States, more than 1 in 3 people lived beyond a 90-minute drive of a high-volume pancreatic cancer surgery center, mostly in rural, socially vulnerable communities.
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Changes in surgical quality and access after rural hospital closures
After rural hospitals closed, Medicare patients who lost their nearest or second-nearest hospital showed no significant change in the quality of common operations; those who lost their nearest hospital traveled farther for surgery.
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Poverty and Its Impact on Surgical Care
This review describes how poverty, which extends beyond finances to barriers involving health care infrastructure, geographic isolation and education, results in persistent disparities in access to high-quality surgical care, with heightened risks for minority patients.
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Development of Neighborhood Trajectories Employing Historic Redlining and the Area Deprivation Index
Using historic redlining maps for the entire United States and current neighborhood deprivation scores, researchers built “Neighborhood Trajectories,” a new approach to studying structural racism that may help investigate gentrification and “White flight.”
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Among US heart transplant recipients who survived at least 1 year, average or high social vulnerability scores were associated with a higher risk of death over long-term follow-up than low scores.
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For Medicare patients having common inpatient operations, living in a more deprived neighborhood and being treated at a lower-quality hospital were each associated with a higher risk of death within 30 days.
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Residential Redlining, Neighborhood Trajectory, and Equity of Breast and Colorectal Cancer Care
In Indiana cities, persistently disadvantaged neighborhoods, compared with persistently advantaged ones, were associated with late-stage breast and colorectal cancer diagnosis; in gentrified neighborhoods, Black patients were less likely than White patients to have cancer surgery.
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In California, patients having complex cancer surgery who lived in historically redlined areas were less likely to have it at a high-volume hospital, a gap largely explained by factors such as insurance and minority status.
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Among California patients with emergency surgical conditions or trauma, few had diagnosis codes recording social or economic hardship; those who did had no more complications or deaths but longer stays and more nursing-facility discharges.
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Among California patients having surgery for lung, pancreas, colon or rectal cancer, few had diagnosis codes recording social or economic hardship; those who did had longer stays and were more often discharged to nursing facilities.
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The Association of Persistent Poverty and Outcomes Among Patients Undergoing Cardiac Surgery
Among Medicare patients having heart bypass or valve surgery, those from persistently poor counties were more likely to die in the short and long term than those from counties that never had high poverty.
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Compared with Medicare patients from the least socially vulnerable communities, those from the most vulnerable more often had unplanned surgery for conditions best treated with planned surgery, and higher rates of death and additional surgery.
More on this study: In vulnerable communities, surgery is more often unplanned
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Disparity in Clinical Trial Participation Among Patients with Gastrointestinal Cancer
Among US adults who had surgery for digestive-tract cancer, clinical trial participation was low, and Black patients (compared with White patients) and those with Medicare, Medicaid or less education were less likely to enroll.
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Understanding Racially Diverse Community Member Views of Obesity Stigma and Bariatric Surgery
In interviews with mostly Black community members who qualified for weight-loss surgery but had never considered it, obesity stigma was the main reason for rejecting surgery, which they viewed as an illegitimate shortcut.
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Emergency Surgery Rates Among Medicare Beneficiaries With Access Sensitive Surgical Conditions
Among Medicare patients having surgery for abdominal aortic aneurysm, colorectal cancer or hernia at an old incision, emergency operations were common, varied almost fivefold across US areas, and were associated with more deaths and readmissions.
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Among White and Black Medicare patients having inpatient surgery, living in a less deprived neighborhood was associated with better outcomes for both groups, but the association was stronger for White patients.
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Among Medicare patients having heart, blood vessel or abdominal surgery, greater upward economic mobility was associated with better outcomes, and racial differences in death were smaller at the highest mobility level.
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For Medicare patients having liver or pancreas surgery, those from the most socially vulnerable counties had higher risks of death and complications than the least vulnerable, but fared considerably better at high- than low-quality hospitals.
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Rural hospitals are not associated with worse postoperative outcomes for colon cancer surgery
For Medicare patients from rural counties having colon cancer surgery, complications, deaths and hospital spending were similar whether they were treated at rural or nonrural hospitals.
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Among Medicare patients readmitted after liver or pancreas surgery, those with higher social vulnerability were more likely to be readmitted to a different hospital from the one where they had surgery.
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Across US counties, greater community economic distress was associated with lower breast and colorectal cancer screening rates and higher death rates from these cancers.
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Among older Medicare patients having surgery, greater social vulnerability, including economic disadvantage and household and disability factors, was associated with lower odds of an ideal recovery, most strongly in minority patients.
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For Medicare patients having common operations, living in a neighborhood historically “redlined” as “Hazardous” was associated with higher death and complication rates than living in one graded “Best,” even after accounting for present-day neighborhood disadvantage.
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Geographic Disparities in Oncologic Treatment and Outcomes: The Urban-Rural Divide
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Among Medicare patients having lung, heart, aneurysm or colon surgery, distinct social vulnerability profiles were associated with different outcomes, even among patients with similar overall vulnerability scores, and more vulnerable profiles had worse outcomes.
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Medicare patients having pancreas surgery who lived in counties with low racial diversity were less likely to have an ideal recovery, and more likely to be readmitted or die, than those in high-diversity counties.
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For patients having bile duct cancer surgery, treatment at hospitals serving the most Black and Hispanic patients was associated with less guideline-recommended care, and missing such care was associated with worse long-term outcomes.
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Among Medicare patients having colon, heart bypass, lung or joint replacement surgery, those from highly socially vulnerable counties generally had worse outcomes, and this pattern was most pronounced among Black and other minority patients.
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For Medicare patients having lung, esophageal, colon or rectal cancer surgery, living in a less racially integrated county was associated with higher odds of complications, longer stays and death, and fewer problem-free recoveries.
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For Medicare patients having lung or colon cancer surgery, those from counties with high social vulnerability and low residential diversity were more likely to die within 30 days than those from low-vulnerability, high-diversity counties.
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Among older Medicare patients with early-stage pancreatic cancer, those living in more socially vulnerable counties were less likely to have surgery to remove the tumor, especially Black and Latino patients.
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For Medicare patients having pancreas surgery, those from highly socially vulnerable counties treated at hospitals in less racially and ethnically integrated communities had the lowest chance of a problem-free recovery.
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For Californians with amputated fingers, few hospitals performed many reattachment surgeries, travel was a barrier to reaching them, and a model shifting cases to selected centers raised volumes and shortened travel times.
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Among Medicare patients having cancer surgery on the liver or pancreas, those from more socially vulnerable counties were less likely to have surgery at high-volume hospitals, where their higher complication risk appeared partly reduced.
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High Social Vulnerability and "Textbook Outcomes" after Cancer Operation
Among Medicare patients having lung, esophageal, colon or rectal cancer surgery, only about half had a problem-free recovery, and those from socially vulnerable areas, especially non-White patients, were less likely to have one.
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For patients with early-stage liver cancer, this study examined how county social vulnerability and patient race and ethnicity, alone and together, related to the chance of having surgery or a transplant.
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Trends in the Geospatial Distribution of Inpatient Adult Surgical Services across the United States
Across the United States between 2005 and 2015, rural hospitals offering surgery declined while major surgical hospitals increased, and the number of people living more than a 60-minute drive from a surgical hospital nearly doubled.
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Rural Surgery and Status of the Rural Workplace: Hospital Survival and Economics
This review concludes that surgery can be safely performed in rural hospitals, but that rural hospital closures, which seem to be accelerating, may put rural residents at greater risk from surgical conditions.
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Examining healthcare inequities relative to United States safety net hospitals
For adults having heart bypass, colon surgery or hip replacement, patients at hospitals with the heaviest safety-net burden had worse outcomes, and racial minority patients had more complications than White patients regardless of safety-net burden.
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Across the United States from 2005 to 2015, the number of people living more than a 60-minute drive from a hospital with an approved cancer program nearly doubled, and their communities were poorer.
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In California, most liver surgery patients bypassed their nearest hospital, usually for a high-volume one, but about one-quarter had surgery at low-volume hospitals, and Medicaid patients were less likely to be treated at high-volume hospitals.
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Among Medicare patients having colon surgery for diverticulitis or colon cancer, those from more socially vulnerable counties were more likely to have an emergency rather than planned operation and had higher complication risk.
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In California, patients having high-risk cancer surgery on the esophagus, lung, pancreas or rectum who lived in highly socially vulnerable counties were less likely to have their operation at a high-volume hospital.
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Among Medicare patients who had surgery for pancreatic cancer, women and older patients waited longer from first symptoms to diagnosis, and women also waited longer from diagnosis to surgery.
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Among Medicare patients having liver or pancreas surgery, one-half had an ideal recovery free of complications, long stays, and 90-day readmission or death; higher social vulnerability was associated with lower chances of achieving it.
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Regionalization of Pancreatectomy for Pancreatic Cancer-Reply
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Optimal Location for Centralization of Hospitals Performing Pancreas Resection in California
This study examines where in California hospitals performing a major pancreas operation could best be located if the operation were concentrated at fewer hospitals.
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Accessing surgical care for esophageal cancer: patient travel patterns to reach higher volume center
In California, most patients having surgery for esophageal cancer bypassed their nearest hospital, yet most of them did not go to a high-volume hospital, and nearly two-thirds of patients had surgery at a low-volume hospital.
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In California, most patients having surgery for pancreatic cancer bypassed their nearest hospital for a higher-volume one, and surgery at high-volume hospitals was associated with lower mortality, yet nearly 1 in 5 used low-volume hospitals.
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Geographic Distribution of Adult Inpatient Surgery Capability in the USA
Across the United States, a sizable share of people live more than 30 straight-line miles from a major surgical hospital, and proximity to surgical hospitals varied with demographic and socioeconomic factors, suggesting disparities in access.
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Among adults in 17 states operated on the day of admission for life-threatening general surgery emergencies, having emergency general surgeons and recovery room nurses on site around the clock was associated with fewer deaths.
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In California, the Affordable Care Act’s bonus payment for general surgeons in health professional shortage areas was associated with more surgeries at the two shortage-area hospitals relative to other hospitals, reversing a downward trend.