Table 4.
—Factors Associated With Guideline-Consistent Care
| Univariate Analysis | Multivariate Analysis | ||||
| Variables | Patients Receiving Guideline-Consistent Care, % | Crude OR (95% CI) | P Value | Crude OR (95% CI) | P Value |
| Patient age, y | |||||
| 66-70 | 22.6 | Reference | … | Reference | … |
| 71-75 | 20.7 | 0.90 (0.81-0.99) | .03 | 0.93 (0.83-1.03) | .17 |
| 76-80 | 20.5 | 0.89 (0.80-0.99) | .03 | 0.86 (0.77-0.96) | .008 |
| > 80 | 15.0 | 0.61 (0.53-0.70) | < .0001 | 0.63 (0.55-0.74) | < .0001 |
| Patient sex | |||||
| Male | 20.6 | Reference | … | … | … |
| Female | 22.3 | 1.10 (1.02-1.19) | .02 | … | … |
| Patient race | |||||
| White | 21.9 | Reference | … | … | … |
| Hispanic | 19.3 | 0.85 (0.70-1.04) | .11 | … | … |
| Black | 19.0 | 0.84 (0.71-0.98) | .03 | … | … |
| Other | 16.0 | 0.68 (0.53-0.86) | .002 | … | … |
| Urban/rural | |||||
| Big metro | 22.4 | Reference | … | Reference | … |
| Metro | 21.2 | 0.93 (0.84-1.02) | .11 | 1.28 (1.1-1.49) | .001 |
| Urban | 19.4 | 0.83 (0.71-0.98) | .03 | 1.11 (0.89-1.39) | .36 |
| Less urban | 19.2 | 0.82 (0.71-0.95) | .008 | 1.12 (0.90-1.38) | .31 |
| Rural | 18.2 | 0.77 (0.57-1.04) | .09 | 1.12 (0.79-1.59) | .51 |
| Year of diagnosis | |||||
| 1995 | 22.6 | Reference | … | … | … |
| 1996 | 18.7 | 0.79 (0.57-1.09) | .15 | … | … |
| 1997 | 21.3 | 0.93 (0.67-1.27) | .63 | … | … |
| 1998 | 20.8 | 0.90 (0.65-1.24) | .51 | … | … |
| 1999 | 23.3 | 1.04 (0.75-1.45) | .80 | … | … |
| 2000 | 21.2 | 0.92 (0.70-1.20) | .54 | … | … |
| 2001 | 21.5 | 0.94 (0.73-1.21) | .62 | … | … |
| 2002 | 18.9 | 0.80 (0.62-1.03) | .08 | … | … |
| 2003 | 22.1 | 0.97 (0.76-1.25) | .83 | … | … |
| 2004 | 22.7 | 1.01 (0.79-1.29) | .95 | … | … |
| 2005 | 19.8 | 0.84 (0.66-1.08) | .18 | … | … |
| 2006 | 21.8 | 0.95 (0.74-1.22) | .71 | … | … |
| 2007 | 23.3 | 1.04 (0.81-1.33) | .76 | … | … |
| SEER/TCR region | |||||
| California | 22.0 | Reference | … | Reference | … |
| Atlanta and rural Georgia | 14.8 | 0.62 (0.47-0.81) | .0005 | 0.68 (0.47-0.99) | .04 |
| Connecticut | 23.2 | 1.07 (0.91-1.27) | .42 | 0.83 (0.64-1.08) | .17 |
| Detroit | 27.8 | 1.37 (1.18-1.59) | < .0001 | 1.04 (0.78-1.37) | .80 |
| Hawaii | 12.4 | 0.51 (0.33-0.78) | .002 | 0.48 (0.26-0.87) | .02 |
| Iowa | 16.7 | 0.71 (0.59-0.86) | .0003 | 1.15 (0.86-1.54) | .36 |
| Kentucky | 17.8 | 0.77 (0.65-0.92) | .003 | 0.64 (0.48-0.86) | .003 |
| Louisiana | 11.7 | 0.47 (0.37-0.59) | < .0001 | 0.64 (0.47-0.86) | .004 |
| New Jersey | 26.3 | 1.27 (1.10-1.47) | .001 | 1.14 (0.91-1.43) | .25 |
| New Mexico | 22.2 | 1.02 (0.73-1.42) | .93 | 1.16 (0.72-1.85) | .54 |
| Seattle | 24.6 | 1.16 (0.94-1.42) | .17 | 1.42 (1.06-1.90) | .02 |
| Texas | 21.4 | 0.97 (0.86-1.09) | .58 | 1.22 (1.00-1.48) | .048 |
| Utah | 28.9 | 1.44 (0.99-2.12) | .06 | 2.18 (1.33-3.57) | .002 |
| % Povertya | |||||
| ≤ 4.76 | 24.7 | Reference | … | Reference | … |
| 4.77-9.07 | 20.7 | 0.80 (0.71-0.89) | < .0001 | 0.83 (0.74-0.93) | .002 |
| 9.08-16.53 | 21.6 | 0.84 (0.75-0.94) | .002 | 0.93 (0.81-1.06) | .27 |
| > 16.53 | 18.2 | 0.68 (0.60-0.76) | < .0001 | 0.81 (0.71-0.94) | .004 |
| Unknown | 23.4 | 0.94 (0.76-1.16) | .54 | 1.16 (0.63-2.11) | .64 |
| % Non-high schoolb | |||||
| ≤ 10.09 | 23.9 | Reference | … | … | … |
| 10.1-17.18 | 21.3 | 0.87 (0.77-0.97) | .01 | … | … |
| 17.19-27.8 | 21.6 | 0.88 (0.79-0.98) | .02 | … | … |
| > 27.85 | 18.3 | 0.72 (0.64-0.81) | < .0001 | … | … |
| Unknown | 23.4 | 0.98 (0.79-1.21) | .83 | … | … |
| Comorbidity | |||||
| 0 | 21.8 | Reference | … | … | … |
| 1 | 21.7 | 0.99 (0.90-1.09) | .84 | … | … |
| 2+ | 19.8 | 0.88 (0.79-0.99) | .03 | … | … |
| T stages | |||||
| T1 (include T0) | 29.7 | Reference | … | Reference | … |
| T2 | 18.2 | 0.53 (0.48-0.58) | < .0001 | 0.66 (0.60-0.74) | < .0001 |
| T3 | 13.7 | 0.38 (0.32-0.45) | < .0001 | 0.52 (0.43-0.64) | < .0001 |
| Unknown | 24.3 | 0.76 (0.68-0.85) | < .0001 | 1.12 (0.96-1.3) | .14 |
| Physician sex | |||||
| Male | 21.5 | Reference | … | Reference | … |
| Female | 12.9 | 0.54 (0.44-0.66) | < .0001 | 0.78 (0.61-1.00) | .05 |
| Unknown | 25.4 | 1.25 (1.11-1.40) | .0003 | … | … |
| Physician graduation year | |||||
| Prior to 1980 | 20.0 | Reference | … | Reference | … |
| 1980-1989 | 22.0 | 1.13 (1.03-1.24) | .01 | 1.31 (1.13-1.52) | .0003 |
| After 1990 | 21.1 | 1.07 (0.95-1.21) | .28 | 1.68 (1.39-2.03) | < .0001 |
| Unknown | 25.4 | 1.37 (1.21-1.55) | < .0001 | 1.95 (1.26-3.01) | .003 |
| Trained in the United States | |||||
| Yes | 22.9 | Reference | … | Reference | … |
| No | 15.5 | 0.62 (0.56-0.69) | < .0001 | 0.69 (0.59-0.82) | < .0001 |
| Unknown | 24.5 | 1.10 (0.96-1.25) | .17 | 1.09 (0.70-1.70) | .70 |
| Degree | |||||
| MD | 21.4 | Reference | … | … | … |
| DO | 15.6 | 0.68 (0.55-0.85) | .0005 | … | … |
| Unknown | 24.5 | 1.20 (1.05-1.36) | .007 | … | … |
| Total No. of patients | |||||
| 1 | 16.5 | Reference | … | Reference | … |
| 2-5 | 22.1 | 1.43 (1.29-1.60) | < .0001 | 1.47 (1.26-1.71) | < .0001 |
| 6-10 | 23.4 | 1.54 (1.37-1.73) | < .0001 | 1.86 (1.50-2.30) | < .0001 |
| > 10 | 25.4 | 1.72 (1.52-1.94) | < .0001 | 1.45 (1.09-1.93) | .01 |
| Specialty of physicianc | |||||
| Pulmonary | 13.2 | Reference | … | Reference | … |
| Internal medicine | 11.5 | 0.86 (0.75-0.97) | .02 | 0.97 (0.80-1.17) | .75 |
| General surgery | 36.4 | 3.77 (3.21-4.42) | < .0001 | 4.26 (3.36-5.40) | < .0001 |
| Thoracic surgery | 67.5 | 13.71 (12.22-15.38) | < .0001 | 14.79 (12.46-17.55) | < .0001 |
| Other | 4.3 | 0.30 (0.19-0.47) | < .0001 | 0.37 (0.23-0.61) | < .0001 |
| Unknown | 8.8 | 0.64 (0.5-0.81) | .0002 | 0.46 (0.32-0.64) | < .0001 |
See Table 1 legend for expansion of abbreviations.
a
% Poverty is the percentage of people living in that patient’s census tract living below the poverty level. The variable itself has a P value of .036.
b
% Without a high school education is the percentage of people living in that patient’s census tract with that level of education.
c
Refers to the physician who ordered or performed the first invasive diagnostic test. For bronchoscopy and surgical procedures, this was the physician performing the procedure. For CT scan-guided biopsy, this was the referring physician. Internal medicine includes family practice and all subspecialties of internal medicine other than pulmonary medicine physicians. Surgery includes all other subspecialties of surgery other than thoracic or cardiothoracic surgery. Thoracic surgery and cardiothoracic surgery are included under thoracic surgery.