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Association Between Historical Redlining and Access to High-Volume Hospitals Among Patients Undergoing Complex Cancer Surgery in California

  • Global Health Services Research
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We sought to determine the impact of historical redlining on travel patterns and utilization of high-volume hospitals (HVHs) among patients undergoing complex cancer operations.

Methods

The California Department of Health Care Access and Information database was utilized to identify patients who underwent esophagectomy (ES), pneumonectomy (PN), pancreatectomy (PA), or proctectomy (PR) for cancer between 2010 and 2020. Patient ZIP codes were assigned Home Owners’ Loan Corporation grades (A: ‘Best’; B: ‘Still Desirable’; C: ‘Definitely Declining’; and D: ‘Hazardous/Redlined’). A clustered multivariable regression was used to assess the likelihood of patients undergoing surgery at an HVH, bypassing the nearest HVH, and total real driving time and travel distance.

Results

Among 14,944 patients undergoing high-risk cancer surgery (ES: 4.7%, n = 1216; PN: 57.8%, n = 8643; PD: 14.4%, n = 2154; PR: 23.1%, n = 3452), 782 (5.2%) individuals resided in the ‘Best’, whereas 3393 (22.7%) individuals resided in redlined areas. Median travel distance was 7.8 miles (interquartile range [IQR] 4.1–14.4) and travel time was 16.1 min (IQR 10.7–25.8). Overall, 10,763 (ES: 17.4%; PN: 76.0%; PA: 63.5%; PR: 78.4%) patients underwent surgery at an HVH. On multivariable regression, patients residing in redlined areas were less likely to undergo surgery at an HVH (odds ratio [OR] 0.67, 95% confidence interval [CI] 0.54–0.82) and were more likely to bypass the nearest hospital (OR 1.80, 95% CI 1.44–2.46). Notably, Medicaid insurance, minority status, limited English-language proficiency, and educational level mediated the disparities in access to HVH.

Conclusion

Surgical disparities in access to HVH among patients from historically redlined areas are largely mediated by social determinants such as insurance and minority status.

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Data Availability

The data for this study were obtained from the California Department of Health Care Access and Information (HCAI) database. There are restrictions to the availability of these data, which is used under license for this study. Data can be accessed with permission from the California Health and Human Services Agency.

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Acknowledgement

None.

Funding

JC receives funding from The Ohio State University Comprehensive Cancer Center Pelotonia Grant. SO-G is funded by The Ohio State University Comprehensive Cancer Center Pelotonia Grant, Paul Calabresi Career Development Award (K12 CA133250), Conquer Cancer Breast Cancer Research Foundation Advanced Clinical Research Award for Diversity and Inclusion in Breast Cancer Research, The Society of University Surgeons, and The American Cancer Society (RSG-22-106-01-CSCT).

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Authors and Affiliations

  1. Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA

    Mujtaba Khalil MD, Muhammad Musaab Munir MD, Selamawit Woldesenbet PhD, Erryk Katayama BA, Adrian Diaz MD, JC Chen MD, Samilia Obeng-Gyasi MD, MPH & Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.)

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  1. Mujtaba Khalil MD
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Correspondence to Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.).

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Mujtaba Khalil, Muhammad Musaab Munir, Selamawit Woldesenbet, Erryk Katayama, Adrian Diaz, JC Chen, Samilia Obeng-Gyasi, and Timothy M. Pawlik have no conflicts of interest to declare.

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Khalil, M., Munir, M.M., Woldesenbet, S. et al. Association Between Historical Redlining and Access to High-Volume Hospitals Among Patients Undergoing Complex Cancer Surgery in California. Ann Surg Oncol 31, 1477–1487 (2024). https://doi.org/10.1245/s10434-023-14679-7

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