Table 2.

—Factors Associated With Receipt of Each Treatment Strategy

Factor	Surgery Compared With No Local Treatment	EBRT Compared With Surgery	IMRT Compared With Surgery	SBRT/Proton Therapy Compared With Surgery
Age
67-69 y	Ref	Ref	Ref	Ref
70-74 y	0.84 (0.68-1.05)	1.23 (0.96-1.58)	1.20 (0.58-2.49)	1.22 (0.49-3.04)
75-79 y	0.57 (0.46-0.70)	2.07 (1.62-2.64)	1.50 (0.71-3.08)	1.35 (0.55-3.35)
80-84 y	0.32 (0.26-0.40)	5.06 (3.87-6.61)	2.22 (0.98-5.05)	4.51 (1.68-12.12)
85-94 y	0.12 (0.09-0.16)	13.80 (9.94-19.15)	3.27 (1.16-9.17)	21.65 (6.2-74.92)
Sex
Male	Ref	Ref	Ref	Ref
Female	1.14 (1.0-1.30)	1.19 (1.02-1.39)	0.81 (0.50-1.31)	1.66 (0.93-2.95)
Race
White	Ref	Ref	Ref	Ref
Black	0.43 (0.34-0.54)	1.17 (0.84-1.62)	1.60 (0.70-3.65)	1.79 (0.61-5.25)
Other	0.57 (0.42-0.78)	0.73 (0.46-1.13)	0.99 (0.30-3.23)	0.30 (0.04-2.26)
Marital status
Married	Ref	Ref	Ref	Ref
Not married	0.65 (0.57-0.75)	1.31 (1.12-1.54)	2.22 (1.34-3.70)	1.15 (0.65-2.03)
Unknown	0.66 (0.47-0.93)	1.68 (1.14-2.48)	2.04 (0.53-7.89)	1.16 (0.23-5.79)
Residence
Urban	Ref	Ref	Ref	Ref
Rural	1.19 (0.85-1.65)	0.85 (0.57-1.26)	0.50 (0.12-2.06)	0.18 (0.03-1.18)
Other	1.02 (0.82-1.25)	0.95 (0.74-1.22)	0.98 (0.45-2.11)	0.76 (0.30-1.94)
Comorbidities
0	Ref	Ref	Ref	Ref
1-2	0.85 (0.73-0.98)	1.96 (1.63-2.36)	3.21 (1.61-6.40)	1.61 (0.82-3.18)
≥ 3	0.47 (0.39-0.55)	4.81 (3.91-5.92)	3.33 (1.58-7.02)	1.60 (0.75-3.40)
Tumor size
T1a	Ref	Ref	Ref	Ref
T1b	0.64 (0.55-0.75)	1.68 (1.40-2.00)	1.66 (0.94-2.93)	1.19 (0.66-2.13)
T2a	0.57 (0.48-0.66)	1.86 (1.55-2.23)	1.96 (1.09-3.52)	0.58 (0.28-1.18)
Histology
Adenocarcinoma	Ref	Ref	Ref	Ref
Bronchioloalveolar carcinoma	1.65 (1.28-2.12)	0.22 (0.14-0.32)	0.64 (0.25-1.65)	0.29 (0.09-0.90)
Squamous cell	0.81 (0.70-0.94)	1.67 (1.41-1.98)	1.32 (0.75-2.34)	0.79 (0.42-1.49)
Large cell	0.78 (0.57-1.07)	1.41 (1.01-1.98)	0.79 (0.21-2.93)	0.12 (0.01-1.58)
Other	0.08 (0.07-0.10)	11.82 (9.38-14.91)	12.59 (6.26-25.30)	12.34 (4.80-31.73)
Chemotherapy
No	Ref	Ref	Ref	Ref
Yes	0.52 (0.42-0.63)	8.06 (6.56-9.90)	3.17 (1.74-5.78)	0.23 (0.05-0.97)
Influenza vaccine
No	Ref	Ref	Ref	Ref
Yes	1.77 (1.56-2.01)	0.95 (0.82-1.11)	0.99 (0.61-1.61)	1.19 (0.67-2.10)
COPD admission
No	Ref	Ref	Ref	Ref
Yes	0.32 (0.23-0.44)	3.29 (2.29-4.72)	4.46 (1.71-11.64)	7.36 (2.0-27.20)
HRR characteristicsa
Medicare expenditures			1.00 (1.00-1.00)	1.00 (1.00-1.00)
Hospital Compare quality scoreb	1.02 (0.97-1.07)	0.88 (0.82-0.94)	0.77 (0.66-0.89)
Percentage of surgeries performed using VATSc
< 8.6	Ref	Ref	Ref	Ref
8.7-12.3	1.06 (0.82-1.35)	0.93 (0.61-1.42)	0.97 (0.36-2.67)	2.70 (0.80-9.14)
13.6-18.1	1.11 (0.84-1.46)	1.07 (0.66-1.71)	0.96 (0.29-3.23)	1.48 (0.38-5.69)
18.4-26.6	0.95 (0.73-1.24)	0.93 (0.58-1.50)	1.15 (0.38-3.51)	0.60 (0.14-2.60)
26.7-70.5	1.28 (0.95-1.73)	0.83 (0.49-1.41)	1.36 (0.40-4.56)	0.44 (0.09-2.28)

Data are presented as OR (95% CI). HRR = hospital referral region; Ref = reference; VATS = video-assisted thoracoscopic surgery. See Table 1 legend for expansion of other abbreviations.

^aModels were adjusted for the following HRR variables: percentage of doctors in primary care specialty, total Medicare reimbursement, percentage non-health maintenance organization mortality (adjusted) (2006), Centers for Medicare & Medicaid Services Hospital Compare composite and state requirement for certificate of need for radiation. For clarity, only two are shown in the table.

^bCenters for Medicare & Medicaid Services Hospital Compare technical process quality measures composite quality score (acute myocardial infarction, congestive heart failure, and pneumonia) (2007).

^cVATS ORs are from separate models using the same variables but only including HRRs where at least 20 VATS were performed.