Table 4:
Association of healthcare affordability, accessibility and availability with debulking surgery performed by a gynecologic oncologist (N=8,155)
| Parameter | Model 1 | Model 2 | Model 3 | Model 4 | Model 5 |
|---|---|---|---|---|---|
| Clinical | Clinical + Affordability | Clinical + Accessibility | Clinical+Availability | All covariates | |
| Race (ref: Non-Hispanic White) | |||||
| Non-Hispanic Black | 0.83 (0.70–0.98) | 0.91 (0.77–1.08) | 0.83 (0.71–0.98) | 0.87 (0.74–1.02) | 0.91 (0.77–1.08) |
| Hispanic | 0.97 (0.84–1.12) | 1.03 (0.89–1.20) | 0.97 (0.84–1.12) | 0.99 (0.86–1.15) | 1.03 (0.89–1.19) |
| Age at diagnosis (ref: 65–70) | |||||
| 71–75 | 0.94 (0.87–1.01) | * | * | * | * |
| 76–80 | 0.85 (0.77–0.93) | * | * | * | * |
| 81+ | 0.56 (0.51–0.63) | * | * | * | * |
| Stage at diagnosis (ref: IV) | |||||
| I | 1.50 (1.32–1.71) | * | * | * | * |
| II | 1.98 (1.74–2.25) | * | * | * | * |
| III | 1.98 (1.81–2.16) | * | * | * | * |
| Tumor histology (ref: Type I epithelial) | |||||
| Type II epithelial | 0.99 (0.90–1.10) | * | * | * | * |
| Other | 0.60 (0.37–0.99) | * | * | * | * |
| Married | 1.10 (1.03–1.17) | * | * | * | * |
| Dual enrolled in Medicaid | 0.85 (0.75–0.97) | 0.86 (0.76–0.97) | |||
| Census tract in highest quartile: | |||||
| Adults < high school education | 1.02 (0.92–1.13) | 1.03 (0.93–1.15) | |||
| Residents of Black race | 0.94 (0.85–1.03) | 0.96 (0.87–1.06) | |||
| Households in poverty | 0.99 (0.89–1.09) | 0.97 (0.87–1.08) | |||
| % county residents without health insurance | 0.98 (0.98–0.99) | 0.99 (0.98–1.00) | |||
| Lives in metro area | 1.02 (0.93–1.12) | 1.01 (0.91–1.12) | |||
| Distance to treatment facility (ref: 0–5 miles) | |||||
| 5–10 miles | 1.06 (0.98–1.15) | 1.05 (0.96–1.14) | |||
| 10–20 miles | 1.04 (0.95–1.14) | 1.01 (0.92–1.11) | |||
| 20–50 miles | 1.14 (1.03–1.27) | 1.10 (0.99–1.23) | |||
| 50+ miles | 1.01 (0.89–1.16) | 0.98 (0.85–1.12) | |||
| Missing | 0.20 (0.03–1.31) | 0.21 (0.03–1.40) | |||
| PCPs per 1K county population | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | |||
| HRR: % Hospital discharges 30-day readmission | 0.96 (0.91–1.01) | 0.97 (0.91–1.03) | |||
| HRR: % Hospital discharges 30-day ER visit | 1.02 (0.99–1.05) | 1.02 (0.98–1.06) | |||
| HRR: Physicians per 100K population | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | |||
| HRR: Heme/Onc per 100K population | 0.97 (0.91–1.04) | 0.96 (0.90–1.03) | |||
| HRR: Ob-Gyns per 100K women aged 15–44 | 1.00 (0.99–1.00) | 1.00 (0.99–1.00) | |||
| HRR: % Medicare patients died diagnosis year | 0.89 (0.77–1.02) | 0.90 (0.78–1.05) | |||
| HRR: % Medicare patients saw PCP diagnosis year | 1.02 (1.01–1.03) | 1.02 (1.01–1.03) | |||
| HRR: Ambulatory sensitive discharges per 1K | 1.00 (1.00–1.01) | 1.00 (1.00–1.01) | |||
| Main facility: highest OC surgical volume (age 65+ only) | 1.14 (1.06–1.23) | 1.12 (1.04–1.21) | |||
| Main facility: affiliated with medical school | 1.01 (0.94–1.09) | 1.01 (0.94–1.09) | |||
| Main facility: has NCI cancer center | 0.99 (0.89–1.10) | 0.98 (0.88–1.09) |
Log-binomial regression for relative risk (RR) of receiving debulking surgery performed by a gynecologic oncologist in the 2 months prior/6 months post- OC diagnosis. Affordability, accessibility, and availability metrics were added in stages. All models additionally adjusted for patient geographic region and patient comorbid conditions.
*
Included in model but estimates not shown.
Abbreviations: primary care physician (PCP); healthcare referral region (HRR); ovarian cancer (OC); hematologic oncologist (HemeOnc); obstetrician-gynecologist (Ob-Gyn); emergency room (ER); National Cancer Institute (NCI).