Objective

The study objective was to understand the impact of race/ethnicity on access to thoracic surgical care for patients undergoing lung resection for cancer.

Methods

We performed a retrospective analysis on 206 consecutive patients who underwent lung resection for cancer (120 female, 86 male; median age 66 years), with respect to how race and ethnicity impact time to referral for thoracic surgery to a major healthcare center. Time between initial radiographic appearance of a lung nodule/mass 1 cm or greater to surgical referral and time from surgical referral to operation were evaluated for 121 White, 30 Asian, 26 Hispanic, 12 African American, and 17 mixed or other race patients. The impact of age, sex, median income of patient's household, national and state Area Deprivation Indices, insurance type, and distance between the patient's domicile and our hospital was evaluated. The influence of the referring physician's practice (hospital-based, hospital-affiliated, or private), internal or external referral, race/ethnicity, and level of specialization was also studied.

Results

African American, Asian, Hispanic, and mixed/other race patients had significantly longer wait times between initial radiographic finding of a lung nodule/mass 1 cm or greater and surgical referral compared with White individuals (median days: African American, 78; Asian, 95; Hispanic, 92; mixed or other, 65; White, 35). Multiple linear regression analysis demonstrated that race/ethnicity was the only significant predictor of prolonged time to surgical referral when adjusted for age, sex, median household income level, national and state Area Deprivation Indices, insurance type, and distance between patient's home and our hospital. The referring physician's type of practice and internal versus external referral were not significant. However, the physician's race/ethnicity and level of specialization had an impact on referral times, with nonspecialists referring patients sooner to thoracic surgery compared with specialists who ordered more workup tests. For all patient races/ethnicities, there was no difference in time between surgical referral and day of operation.

Conclusions

Race and ethnicity have a major impact on the time from initial radiographic appearance of a lung nodule/mass 1 cm or greater to referral for surgical resection for cancer. This study suggests the need to develop strategies to reduce minority wait times and improve timely access to surgery for patients with thoracic malignancies.

Video Abstract

Discussion of how race and ethnicity impact referral time to thoracic surgery discussed by Dr Moises Hernandez.

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中文翻译：

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主要大都市地区胸部肿瘤手术转诊时间的种族和民族差异

客观的

研究目的是了解种族/族裔对因癌症接受肺切除术的患者获得胸外科护理的影响。

方法

我们对 206 名因癌症接受肺切除术的连续患者（120 名女性，86 名男性；中位年龄 66 岁）进行了回顾性分析，分析了种族和民族如何影响转诊到主要医疗保健中心进行胸外科手术的时间。对 121 名白人、30 名亚裔、26 名西班牙裔、12 名非裔美国人和 17 名混血或其他种族患者进行了评估，从影像学上首次出现肺结节/肿块 1 cm 或更大到转诊手术之间的时间以及从转诊手术到手术的时间。评估了年龄、性别、患者家庭收入中位数、国家和州地区贫困指数、保险类型以及患者住所与我们医院之间的距离的影响。转诊医师执业（医院、附属医院或私人）的影响，

结果

与白人相比，非裔美国人、亚裔、西班牙裔和混血/其他种族患者从最初放射影像学发现 1 厘米或更大的肺结节/肿块到手术转诊之间的等待时间明显更长（中位天数：非裔美国人，78 天；亚洲人， 95；西班牙裔，92；混合或其他，65；白人，35）。多元线性回归分析表明，在根据年龄、性别、家庭收入中位数水平、国家和州地区贫困指数、保险类型以及患者家与我们医院之间的距离进行调整后，种族/民族是延长手术转诊时间的唯一重要预测因素. 转诊医师的执业类型以及内部转诊与外部转诊并不重要。然而，医生的种族/民族和专业水平对转诊时间有影响，与下令进行更多检查的专科医生相比，非专科医生更早地将患者转诊至胸外科。对于所有种族/民族的患者，手术转诊和手术日之间的时间没有差异。

结论

种族和族裔对从影像学上首次出现 1 cm 或更大的肺结节/肿块到转诊进行癌症手术切除的时间有重大影响。这项研究表明需要制定策略来减少少数等待时间并改善胸部恶性肿瘤患者及时接受手术的机会。

视频摘要

Moises Hernandez 博士讨论了种族和民族如何影响胸外科转诊时间。

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