Socioeconomic, rural, and insurance-based inequities in robotic lung cancer resections

Abstract

Background: Poor, rural, and underinsured patients with lung cancer experience significant treatment-based disparities. These disparities actually worsen when newer, cutting edge technologies emerge because underserved patients frequently have limited access to these new developments. The robotic surgical technique is a state-of-the-art technology which has proven very beneficial to cancer patients. Unfortunately, it appears that its access is limited by sociodemographic factors at least in surgical, gynecological and urological oncology patients. Whether sociodemographic factors also contribute to disparities in robotic lobectomy for lung cancer patients has not been previously investigated. Methods: We utilized the National Inpatient Sample (NIS) Healthcare Cost and Utilization Project (HCUP) database from 2010 to 2014 to evaluate patient or hospital characteristics affecting the application of robotic versus open or video assisted thoracoscopic surgery (VATS) lobectomy among patients (age ≥18) with a lung cancer diagnosis. Each year of NIS data was trend weighted trend-weighted to represent the population of US inpatients for that year. Multivariable analysis was applied to determine predictors of (a) open versus robotic lobectomy, or predictors of (b) VATS versus robotic lobectomy based on patient and hospital characteristics. Results: The trend-weighted population estimate used for analysis was 139,800 patients categorized as 82,072 (58.7%) open, 48,780 (34.9%) VATS, and 8,948 (6.4%) robotic lobectomy. Low-income patients were less likely to undergo robotic versus open lobectomy (AOR =0.78, P<0.01). Compared to patients in urban teaching hospitals, patients in rural hospitals were much less likely to undergo robotic versus open (AOR =0.28, P<0.01) or VATS (AOR =0.64, P<0.01) lobectomy. Patients with Medicaid were less likely than Medicare patients to undergo robotic compared to open (AOR =0.80, P<0.01) or VATS (AOR =0.88, P=0.049) lobectomy. Uninsured patients were also less likely to undergo robotic versus open (AOR =0.62, P<0.01) or VATS (AOR =0.50, P<0.01) lobectomy. Conclusions: Robotic lobectomy access disparities exist for lung cancer patients based on neighborhood-level income, rural location, and insurance status.