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Adrian Diaz - One of the best experts on this subject based on the ideXlab platform.
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association of Neighborhood Characteristics with utilization of high volume hospitals among patients undergoing high risk cancer surgery
Annals of Surgical Oncology, 2021Co-Authors: Adrian Diaz, Daniel Chavarin, Anghela Z. Paredes, Diamantis I. Tsilimigras, Timothy M. PawlikAbstract:As high-risk cancer surgery continues to become more centralized, it is important to understand the association of Neighborhood Characteristics relative to access to surgical care. We sought to determine the Neighborhood level Characteristics that may be associated with travel patterns and utilization of high-volume hospitals. The California Office of Statewide Health Planning database was used to identify patients who underwent pancreatectomy (PD), esophagectomy (ES), proctectomy (PR), or pneumonectomy (PN) for cancer between 2014 and 2016. Total minutes (m) traveled as well as whether a patient bypassed the nearest hospital that performed the operation to get to a higher-volume center was assessed. Data were merged with the Centers for Disease control social vulnerability index (SVI). Overall, 26,937 individuals (ES: 4.7%; PN: 53.5% PD: 13.9% PR: 27.9%) underwent a complex oncologic operation. Median travel time was 16 m (interquartile range [IQR] 8.3–30.24) [ES: 21.8 m (IQR 10.6–46.9); PN: 14 m (IQR 7.8–27.0); PD: 21.2 m (IQR 10.6–42.6); PR: 15 m (IQR 8.1–28.4)]. Nearly three-quarter of patients (ES: 34%; PN: 73%; PD: 72%; LR: 81%) underwent an operation at a high-volume hospital. For all four operations, patients who resided in a county with a high overall SVI were less likely to have surgery at a high-volume hospital (ES: odds ratio [OR] 0.39, 95% confidence interval [CI] 0.24–0.65; PN: OR: 0.67, 95% CI 0.51–0.88; PD: OR 0.61, 95% CI 0.44–0.84; PR: OR 0.76, 95% CI 0.58–0.98). Patients residing in communities of high social vulnerability were less likely to undergo high-risk cancer surgery at a high-volume hospital. The identification of society-based contextual disparities in access to complex surgical care should serve to inform targeted strategies to direct additional resources toward these vulnerable communities.
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Association of Neighborhood Characteristics with Utilization of High-Volume Hospitals Among Patients Undergoing High-Risk Cancer Surgery
Annals of Surgical Oncology, 2020Co-Authors: Adrian Diaz, Daniel Chavarin, Anghela Z. Paredes, Diamantis I. Tsilimigras, Timothy M. PawlikAbstract:Introduction As high-risk cancer surgery continues to become more centralized, it is important to understand the association of Neighborhood Characteristics relative to access to surgical care. We sought to determine the Neighborhood level Characteristics that may be associated with travel patterns and utilization of high-volume hospitals. Methods The California Office of Statewide Health Planning database was used to identify patients who underwent pancreatectomy (PD), esophagectomy (ES), proctectomy (PR), or pneumonectomy (PN) for cancer between 2014 and 2016. Total minutes (m) traveled as well as whether a patient bypassed the nearest hospital that performed the operation to get to a higher-volume center was assessed. Data were merged with the Centers for Disease control social vulnerability index (SVI). Results Overall, 26,937 individuals (ES: 4.7%; PN: 53.5% PD: 13.9% PR: 27.9%) underwent a complex oncologic operation. Median travel time was 16 m (interquartile range [IQR] 8.3–30.24) [ES: 21.8 m (IQR 10.6–46.9); PN: 14 m (IQR 7.8–27.0); PD: 21.2 m (IQR 10.6–42.6); PR: 15 m (IQR 8.1–28.4)]. Nearly three-quarter of patients (ES: 34%; PN: 73%; PD: 72%; LR: 81%) underwent an operation at a high-volume hospital. For all four operations, patients who resided in a county with a high overall SVI were less likely to have surgery at a high-volume hospital (ES: odds ratio [OR] 0.39, 95% confidence interval [CI] 0.24–0.65; PN: OR: 0.67, 95% CI 0.51–0.88; PD: OR 0.61, 95% CI 0.44–0.84; PR: OR 0.76, 95% CI 0.58–0.98). Conclusions Patients residing in communities of high social vulnerability were less likely to undergo high-risk cancer surgery at a high-volume hospital. The identification of society-based contextual disparities in access to complex surgical care should serve to inform targeted strategies to direct additional resources toward these vulnerable communities.
Timothy M. Pawlik - One of the best experts on this subject based on the ideXlab platform.
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association of Neighborhood Characteristics with utilization of high volume hospitals among patients undergoing high risk cancer surgery
Annals of Surgical Oncology, 2021Co-Authors: Adrian Diaz, Daniel Chavarin, Anghela Z. Paredes, Diamantis I. Tsilimigras, Timothy M. PawlikAbstract:As high-risk cancer surgery continues to become more centralized, it is important to understand the association of Neighborhood Characteristics relative to access to surgical care. We sought to determine the Neighborhood level Characteristics that may be associated with travel patterns and utilization of high-volume hospitals. The California Office of Statewide Health Planning database was used to identify patients who underwent pancreatectomy (PD), esophagectomy (ES), proctectomy (PR), or pneumonectomy (PN) for cancer between 2014 and 2016. Total minutes (m) traveled as well as whether a patient bypassed the nearest hospital that performed the operation to get to a higher-volume center was assessed. Data were merged with the Centers for Disease control social vulnerability index (SVI). Overall, 26,937 individuals (ES: 4.7%; PN: 53.5% PD: 13.9% PR: 27.9%) underwent a complex oncologic operation. Median travel time was 16 m (interquartile range [IQR] 8.3–30.24) [ES: 21.8 m (IQR 10.6–46.9); PN: 14 m (IQR 7.8–27.0); PD: 21.2 m (IQR 10.6–42.6); PR: 15 m (IQR 8.1–28.4)]. Nearly three-quarter of patients (ES: 34%; PN: 73%; PD: 72%; LR: 81%) underwent an operation at a high-volume hospital. For all four operations, patients who resided in a county with a high overall SVI were less likely to have surgery at a high-volume hospital (ES: odds ratio [OR] 0.39, 95% confidence interval [CI] 0.24–0.65; PN: OR: 0.67, 95% CI 0.51–0.88; PD: OR 0.61, 95% CI 0.44–0.84; PR: OR 0.76, 95% CI 0.58–0.98). Patients residing in communities of high social vulnerability were less likely to undergo high-risk cancer surgery at a high-volume hospital. The identification of society-based contextual disparities in access to complex surgical care should serve to inform targeted strategies to direct additional resources toward these vulnerable communities.
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Association of Neighborhood Characteristics with Utilization of High-Volume Hospitals Among Patients Undergoing High-Risk Cancer Surgery
Annals of Surgical Oncology, 2020Co-Authors: Adrian Diaz, Daniel Chavarin, Anghela Z. Paredes, Diamantis I. Tsilimigras, Timothy M. PawlikAbstract:Introduction As high-risk cancer surgery continues to become more centralized, it is important to understand the association of Neighborhood Characteristics relative to access to surgical care. We sought to determine the Neighborhood level Characteristics that may be associated with travel patterns and utilization of high-volume hospitals. Methods The California Office of Statewide Health Planning database was used to identify patients who underwent pancreatectomy (PD), esophagectomy (ES), proctectomy (PR), or pneumonectomy (PN) for cancer between 2014 and 2016. Total minutes (m) traveled as well as whether a patient bypassed the nearest hospital that performed the operation to get to a higher-volume center was assessed. Data were merged with the Centers for Disease control social vulnerability index (SVI). Results Overall, 26,937 individuals (ES: 4.7%; PN: 53.5% PD: 13.9% PR: 27.9%) underwent a complex oncologic operation. Median travel time was 16 m (interquartile range [IQR] 8.3–30.24) [ES: 21.8 m (IQR 10.6–46.9); PN: 14 m (IQR 7.8–27.0); PD: 21.2 m (IQR 10.6–42.6); PR: 15 m (IQR 8.1–28.4)]. Nearly three-quarter of patients (ES: 34%; PN: 73%; PD: 72%; LR: 81%) underwent an operation at a high-volume hospital. For all four operations, patients who resided in a county with a high overall SVI were less likely to have surgery at a high-volume hospital (ES: odds ratio [OR] 0.39, 95% confidence interval [CI] 0.24–0.65; PN: OR: 0.67, 95% CI 0.51–0.88; PD: OR 0.61, 95% CI 0.44–0.84; PR: OR 0.76, 95% CI 0.58–0.98). Conclusions Patients residing in communities of high social vulnerability were less likely to undergo high-risk cancer surgery at a high-volume hospital. The identification of society-based contextual disparities in access to complex surgical care should serve to inform targeted strategies to direct additional resources toward these vulnerable communities.
Demarc A Hickson - One of the best experts on this subject based on the ideXlab platform.
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associations between Neighborhood Characteristics social cohesion and perceived sex partner risk and non monogamy among hiv seropositive and hiv seronegative women in the southern u s
Archives of Sexual Behavior, 2018Co-Authors: Danielle F Haley, Gina M Wingood, Michael R Kramer, Regine Haardorfer, Adaora A Adimora, Anna Rubtsova, Andrew Edmonds, Neela D Goswami, Christina Ludema, Demarc A HicksonAbstract:Neighborhood social and physical factors shape sexual network Characteristics in HIV-seronegative adults in the U.S. This multilevel analysis evaluated whether these relationships also exist in a predominantly HIV-seropositive cohort of women. This cross-sectional multilevel analysis included data from 734 women enrolled in the Women’s Interagency HIV Study’s sites in the U.S. South. Census tract-level contextual data captured socioeconomic disadvantage (e.g., tract poverty), number of alcohol outlets, and number of non-profits in the census tracts where women lived; participant-level data, including perceived Neighborhood cohesion, were gathered via survey. We used hierarchical generalized linear models to evaluate relationships between tract Characteristics and two outcomes: perceived main sex partner risk level (e.g., partner substance use) and perceived main sex partner non-monogamy. We tested whether these relationships varied by women’s HIV status. Greater tract-level socioeconomic disadvantage was associated with greater sex partner risk (OR 1.29, 95% CI 1.06–1.58) among HIV-seropositive women and less partner non-monogamy among HIV-seronegative women (OR 0.69, 95% CI 0.51–0.92). Perceived Neighborhood trust and cohesion was associated with lower partner risk (OR 0.83, 95% CI 0.69–1.00) for HIV-seropositive and HIV-seronegative women. The tract-level number of alcohol outlets and non-profits were not associated with partner risk Characteristics. Neighborhood Characteristics are associated with perceived sex partner risk and non-monogamy among women in the South; these relationships vary by HIV status. Future studies should examine causal relationships and explore the pathways through which Neighborhoods influence partner selection and risk Characteristics.
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the social patterning of sleep in african americans associations of socioeconomic position and Neighborhood Characteristics with sleep in the jackson heart study
Sleep, 2016Co-Authors: Dayna A. Johnson, Lynda D. Lisabeth, Demarc A Hickson, Vicki Johnsonlawrence, Tandaw E Samdarshi, Herman A Taylor, Ana Diez V RouxAbstract:STUDY OBJECTIVES: We investigated cross-sectional associations of individual-level socioeconomic position (SEP) and Neighborhood Characteristics (social cohesion, violence, problems, disadvantage) with sleep duration and sleep quality in 5,301 African Americans in the Jackson Heart Study. METHODS: All measures were self-reported. Sleep duration was assessed as hours of sleep; sleep quality was reported as poor (1) to excellent (5). SEP was measured by categorized years of education and income. Multinomial logistic and linear regression models were fit to examine the associations of SEP and Neighborhood Characteristics (modeled dichotomously and tertiles) with sleep duration (short vs. normal, long vs. normal) and continuous sleep duration and quality after adjustment for demographics and risk factors. RESULTS: The mean sleep duration was 6.4 ± 1.5 hours, 54% had a short (≤ 6 h) sleep duration, 5% reported long (≥ 9 h) sleep duration, and 24% reported fair to poor sleep quality. Lower education was associated with greater odds of long sleep (odds ratio [OR] = 2.19, 95% confidence interval [CI] = 1.42, 3.38) and poorer sleep quality (β = -0.17, 95% CI = -0.27, -0.07) compared to higher education after adjustment for demographics and risk factors. Findings were similar for income. High Neighborhood violence was associated with shorter sleep duration (-9.82 minutes, 95% CI = -16.98, -2.66) and poorer sleep quality (β = -0.11, 95% CI = -0.20, 0.00) after adjustment for demographics and risk factors. Results were similar for Neighborhood problems. In secondary analyses adjusted for depressive symptoms in a subset of participants, most associations were attenuated and only associations of low SEP with higher odds of long sleep and higher Neighborhood violence with poorer sleep quality remained statistically significant. CONCLUSIONS: Social and environmental Characteristics are associated with sleep duration and quality in African Americans. Depressive symptoms may explain at least part of this association.
Ana Diez V Roux - One of the best experts on this subject based on the ideXlab platform.
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the social patterning of sleep in african americans associations of socioeconomic position and Neighborhood Characteristics with sleep in the jackson heart study
Sleep, 2016Co-Authors: Dayna A. Johnson, Lynda D. Lisabeth, Demarc A Hickson, Vicki Johnsonlawrence, Tandaw E Samdarshi, Herman A Taylor, Ana Diez V RouxAbstract:STUDY OBJECTIVES: We investigated cross-sectional associations of individual-level socioeconomic position (SEP) and Neighborhood Characteristics (social cohesion, violence, problems, disadvantage) with sleep duration and sleep quality in 5,301 African Americans in the Jackson Heart Study. METHODS: All measures were self-reported. Sleep duration was assessed as hours of sleep; sleep quality was reported as poor (1) to excellent (5). SEP was measured by categorized years of education and income. Multinomial logistic and linear regression models were fit to examine the associations of SEP and Neighborhood Characteristics (modeled dichotomously and tertiles) with sleep duration (short vs. normal, long vs. normal) and continuous sleep duration and quality after adjustment for demographics and risk factors. RESULTS: The mean sleep duration was 6.4 ± 1.5 hours, 54% had a short (≤ 6 h) sleep duration, 5% reported long (≥ 9 h) sleep duration, and 24% reported fair to poor sleep quality. Lower education was associated with greater odds of long sleep (odds ratio [OR] = 2.19, 95% confidence interval [CI] = 1.42, 3.38) and poorer sleep quality (β = -0.17, 95% CI = -0.27, -0.07) compared to higher education after adjustment for demographics and risk factors. Findings were similar for income. High Neighborhood violence was associated with shorter sleep duration (-9.82 minutes, 95% CI = -16.98, -2.66) and poorer sleep quality (β = -0.11, 95% CI = -0.20, 0.00) after adjustment for demographics and risk factors. Results were similar for Neighborhood problems. In secondary analyses adjusted for depressive symptoms in a subset of participants, most associations were attenuated and only associations of low SEP with higher odds of long sleep and higher Neighborhood violence with poorer sleep quality remained statistically significant. CONCLUSIONS: Social and environmental Characteristics are associated with sleep duration and quality in African Americans. Depressive symptoms may explain at least part of this association.
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change in Neighborhood Characteristics and change in coronary artery calcium a longitudinal investigation in the mesa multi ethnic study of atherosclerosis cohort
Circulation, 2016Co-Authors: Jeffrey J Wing, Brisa N. Sánchez, Ana Diez V Roux, Anjum Hajat, Ella August, Sara D Adar, Andrew L Dannenberg, James H Stein, Matthew C TattersallAbstract:Background: Although some evidence shows that Neighborhood deprivation is associated with greater subclinical atherosclerosis, prior studies have not identified what aspects of deprived Neighborhoods were driving the association. Methods: We investigated whether social and physical Neighborhood Characteristics are related to the progression of subclinical atherosclerosis in 5950 adult participants of the MESA (Multi-Ethnic Study of Atherosclerosis) during a 12-year follow-up period. We assessed subclinical disease using coronary artery calcium (CAC). Neighborhood features examined included density of recreational facilities, density of healthy food stores, and survey-based measures of availability of healthy foods, walking environment, and social environment. We used econometric fixed-effects models to investigate how change in a given Neighborhood exposure is related to simultaneous change in subclinical atherosclerosis. Results: Increases in density of Neighborhood healthy food stores were associated with decreases in CAC (mean changes in CAC Agatston units per 1-SD increase in Neighborhood exposures, −19.99; 95% confidence interval, −35.21 to −4.78) after adjustment for time-varying demographic confounders and computed tomography scanner type. This association remained similar in magnitude after additional adjustment for time-varying behavioral risk factors and depression. The addition of time-varying biomedical factors attenuated associations with CAC slightly (mean changes in CAC per 1-SD increase in Neighborhood exposures, −17.60; 95% confidence interval, −32.71 to −2.49). Changes across time in other Neighborhood measures were not significantly associated with within-person change in CAC. Conclusions: Results from this longitudinal study provide suggestive evidence that greater access to Neighborhood healthy food resources may slow the development of coronary atherosclerosis in middle-aged and older adults.
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associations of Neighborhood Characteristics with sleep timing and quality the multi ethnic study of atherosclerosis
Sleep, 2013Co-Authors: Amy Soo Jin Desantis, Kari Moore, Ana Diez V Roux, Mahasin S Mujahid, Kelly Glazer Baron, Javier F NietoAbstract:Author(s): Desantis, Amy S; Diez Roux, Ana V; Moore, Kari; Baron, Kelly G; Mujahid, Mahasin S; Nieto, F Javier | Abstract: To investigate the associations of specific Neighborhood features (disorder, safety, social cohesion, physical environment, and socioeconomic status) with sleep duration and quality.Cross-sectional. One wave of a population-based study (Multi-Ethnic Study of Atherosclerosis).Community-dwelling participants in New York, NY and Los Angeles, CA.There were 1,406 participants (636 males, 770 females).NA.Sleep was assessed using reported hours of sleep, the Epworth Sleepiness Scale, and insomnia symptoms. Neighborhood Characteristics were assessed via questionnaires administered to neighbors of study participants and were aggregated to the Neighborhood (census tract) level using empirical Bayes estimation. An adverse social environment (characterized by high disorder, and low safety and social cohesion) was associated with shorter sleep duration after adjustment for the physical environment, Neighborhood and individual-level socioeconomic status (SES), and other short sleep risk factors (mean difference per standard deviation increase in summary social environment scale 0.24 h 95% confidence interval 0.08, 0.43). Adverse Neighborhood social and physical environments, and Neighborhood SES were associated with greater sleepiness, but associations with physical environments were no longer statistically significant after adjustment for sociodemographic Characteristics. Neighborhood SES was a weaker and less consistent predictor of specific measures of Neighborhood social and physical environments. Neighborhood Characteristics were not associated with insomnia.Shortened sleep related to adverse social environments represents one potential pathway through which Neighborhoods may influence health.
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associations of Neighborhood Characteristics with sleep timing and quality the multi ethnic study of atherosclerosis
Sleep, 2013Co-Authors: Amy Soo Jin Desantis, Kari Moore, Ana Diez V Roux, Mahasin S Mujahid, Kelly Glazer Baron, Javier F NietoAbstract:Author(s): Desantis, Amy S; Diez Roux, Ana V; Moore, Kari; Baron, Kelly G; Mujahid, Mahasin S; Nieto, F Javier | Abstract: Study objectivesTo investigate the associations of specific Neighborhood features (disorder, safety, social cohesion, physical environment, and socioeconomic status) with sleep duration and quality.DesignCross-sectional. One wave of a population-based study (Multi-Ethnic Study of Atherosclerosis).SettingCommunity-dwelling participants in New York, NY and Los Angeles, CA.ParticipantsThere were 1,406 participants (636 males, 770 females).InterventionsNA.Measurements and resultsSleep was assessed using reported hours of sleep, the Epworth Sleepiness Scale, and insomnia symptoms. Neighborhood Characteristics were assessed via questionnaires administered to neighbors of study participants and were aggregated to the Neighborhood (census tract) level using empirical Bayes estimation. An adverse social environment (characterized by high disorder, and low safety and social cohesion) was associated with shorter sleep duration after adjustment for the physical environment, Neighborhood and individual-level socioeconomic status (SES), and other short sleep risk factors (mean difference per standard deviation increase in summary social environment scale 0.24 h 95% confidence interval 0.08, 0.43). Adverse Neighborhood social and physical environments, and Neighborhood SES were associated with greater sleepiness, but associations with physical environments were no longer statistically significant after adjustment for sociodemographic Characteristics. Neighborhood SES was a weaker and less consistent predictor of specific measures of Neighborhood social and physical environments. Neighborhood Characteristics were not associated with insomnia.ConclusionsShortened sleep related to adverse social environments represents one potential pathway through which Neighborhoods may influence health.
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cross sectional and longitudinal associations of Neighborhood Characteristics with inflammatory markers findings from the multi ethnic study of atherosclerosis
Health & Place, 2010Co-Authors: Aydin Nazmi, Teresa E. Seeman, Ana Diez V Roux, Nalini Ranjit, Nancy S JennyAbstract:We investigated cross-sectional associations of Neighborhood deprivation, problems, safety and cohesion with circulating levels of fibrinogen, interleukin-6 and C-reactive protein (n=5370) and longitudinal associations with changes in IL-6 over a 3–4 year period (n=946). In cross-sectional analyses, higher levels of Neighborhood deprivation and problems were associated with higher levels of all three inflammatory markers, whereas higher levels of safety were associated with lower levels. Fibrinogen remained associated with all Neighborhood Characteristics except cohesion and IL-6 remained associated with safety after adjustment for race and SES. In longitudinal analyses, higher levels of Neighborhood deprivation and problems, and lower levels of safety were associated with greater longitudinal increases in IL-6 after adjustment for age, sex, race and SES. These findings were not substantially modified by further risk factor adjustment. Although findings regarding different inflammatory markers were mixed, the longitudinal results which are less limited by race confounding suggest that inflammatory pathways may contribute to Neighborhood differences in cardiovascular disease risk.
Daniel Chavarin - One of the best experts on this subject based on the ideXlab platform.
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association of Neighborhood Characteristics with utilization of high volume hospitals among patients undergoing high risk cancer surgery
Annals of Surgical Oncology, 2021Co-Authors: Adrian Diaz, Daniel Chavarin, Anghela Z. Paredes, Diamantis I. Tsilimigras, Timothy M. PawlikAbstract:As high-risk cancer surgery continues to become more centralized, it is important to understand the association of Neighborhood Characteristics relative to access to surgical care. We sought to determine the Neighborhood level Characteristics that may be associated with travel patterns and utilization of high-volume hospitals. The California Office of Statewide Health Planning database was used to identify patients who underwent pancreatectomy (PD), esophagectomy (ES), proctectomy (PR), or pneumonectomy (PN) for cancer between 2014 and 2016. Total minutes (m) traveled as well as whether a patient bypassed the nearest hospital that performed the operation to get to a higher-volume center was assessed. Data were merged with the Centers for Disease control social vulnerability index (SVI). Overall, 26,937 individuals (ES: 4.7%; PN: 53.5% PD: 13.9% PR: 27.9%) underwent a complex oncologic operation. Median travel time was 16 m (interquartile range [IQR] 8.3–30.24) [ES: 21.8 m (IQR 10.6–46.9); PN: 14 m (IQR 7.8–27.0); PD: 21.2 m (IQR 10.6–42.6); PR: 15 m (IQR 8.1–28.4)]. Nearly three-quarter of patients (ES: 34%; PN: 73%; PD: 72%; LR: 81%) underwent an operation at a high-volume hospital. For all four operations, patients who resided in a county with a high overall SVI were less likely to have surgery at a high-volume hospital (ES: odds ratio [OR] 0.39, 95% confidence interval [CI] 0.24–0.65; PN: OR: 0.67, 95% CI 0.51–0.88; PD: OR 0.61, 95% CI 0.44–0.84; PR: OR 0.76, 95% CI 0.58–0.98). Patients residing in communities of high social vulnerability were less likely to undergo high-risk cancer surgery at a high-volume hospital. The identification of society-based contextual disparities in access to complex surgical care should serve to inform targeted strategies to direct additional resources toward these vulnerable communities.
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Association of Neighborhood Characteristics with Utilization of High-Volume Hospitals Among Patients Undergoing High-Risk Cancer Surgery
Annals of Surgical Oncology, 2020Co-Authors: Adrian Diaz, Daniel Chavarin, Anghela Z. Paredes, Diamantis I. Tsilimigras, Timothy M. PawlikAbstract:Introduction As high-risk cancer surgery continues to become more centralized, it is important to understand the association of Neighborhood Characteristics relative to access to surgical care. We sought to determine the Neighborhood level Characteristics that may be associated with travel patterns and utilization of high-volume hospitals. Methods The California Office of Statewide Health Planning database was used to identify patients who underwent pancreatectomy (PD), esophagectomy (ES), proctectomy (PR), or pneumonectomy (PN) for cancer between 2014 and 2016. Total minutes (m) traveled as well as whether a patient bypassed the nearest hospital that performed the operation to get to a higher-volume center was assessed. Data were merged with the Centers for Disease control social vulnerability index (SVI). Results Overall, 26,937 individuals (ES: 4.7%; PN: 53.5% PD: 13.9% PR: 27.9%) underwent a complex oncologic operation. Median travel time was 16 m (interquartile range [IQR] 8.3–30.24) [ES: 21.8 m (IQR 10.6–46.9); PN: 14 m (IQR 7.8–27.0); PD: 21.2 m (IQR 10.6–42.6); PR: 15 m (IQR 8.1–28.4)]. Nearly three-quarter of patients (ES: 34%; PN: 73%; PD: 72%; LR: 81%) underwent an operation at a high-volume hospital. For all four operations, patients who resided in a county with a high overall SVI were less likely to have surgery at a high-volume hospital (ES: odds ratio [OR] 0.39, 95% confidence interval [CI] 0.24–0.65; PN: OR: 0.67, 95% CI 0.51–0.88; PD: OR 0.61, 95% CI 0.44–0.84; PR: OR 0.76, 95% CI 0.58–0.98). Conclusions Patients residing in communities of high social vulnerability were less likely to undergo high-risk cancer surgery at a high-volume hospital. The identification of society-based contextual disparities in access to complex surgical care should serve to inform targeted strategies to direct additional resources toward these vulnerable communities.
