The relationship between safety‐net hospital status and outcomes among elderly head and neck cancer patients

Abstract

Background: The impact of safety-net status, case volume, and outcomes among geriatric head and neck cancer patients is unknown.Methods: Chi-square tests and Student's t tests to compare head and neck surgery outcomes of elderly patients between safety-net and non-safety-net hospitals. Multivariable linear regressions to determine predictors of outcome variables including mortality index, ICU stays, 30-day readmission, total direct cost, and direct cost index.Results: Compared with non-safety-net hospitals, safety-net hospitals had a higher average mortality index (1.04 vs. 0.32, p = 0.001), higher mortality rate (1% vs. 0.5%, p = 0.002), and higher direct cost index (p = 0.001). A multivariable model of mortality index found the interaction between safety-net status and medium case volume was predictive of higher mortality index (p = 0.006). Conclusion:Safety-net status is correlated with higher mortality index and cost in geriatric head and neck cancer patients. The interaction between medium volume and safety-net status is independently predictive of higher mortality index.case volume, disparities, head and neck cancer, health disparities, safety-net hospital, socioeconomic status | INTRODUCTIONHead and neck cancer patients represent a socioeconomically vulnerable population. On average, head and neck cancer patients have lower incomes and lower educational attainment compared with patients with other cancers. [1][2][3] The outcomes of head and neck cancer patients are associated with many social and structural determinants of health, including race and ethnicity, socioeconomic status, education level, insurance status, and access to care. 4,5 The intersection of these sociodemographic factors further compounds disparities in cancer outcomes. For instance, Black patients are more likely to be impoverished, uninsured, and less educated-all of these factors contribute to a higher likelihood of advanced disease presentation and decreased survival. 4,6 Safety-net hospitals are important providers of care for patients of racial and ethnic minority backgrounds and low socioeconomic status, who are more likely to be under-or uninsured. 5,7 These hospitals are tasked with caring for a socially and medically complex patient

Socioeconomic Disparities in Postoperative Outcomes of Osteocutaneous Fibula Free Flaps for Head and Neck Reconstruction

“…[15][16][17] These findings are consistent with previous studies that underscore the role of social and structural health determinants, including SES, in shaping the outcomes of HNC patients. 18 The findings contribute to the ongoing discourse, as emphasized by Vincent et al 19 and Kendall and Castro-Alves, 20 about the importance of considering a wide range of factors, including social and structural determinants of health, in achieving optimal outcomes in HNC reconstruction. This study examined the intersection of SES with postoperative complications in individuals undergoing FFF head and neck reconstruction, suggesting the need for a multifaceted approach in patient care and policy formulation.…”