Recent research has raised concern that healthcare segregation, the high concentration of racial groups within a subset of hospitals, is a key contributor to persistent disparities in surgical care. However, to date the extent and effect of hospital level segregation among patients undergoing resection for lung cancer remains unclear.

We used 100% Medicare fee-for-service claims to evaluate the degree of hospital level racial segregation for patients undergoing resection for lung cancer between 2014-2018. Hospitals serving high volume of minority patients were defined as the top decile of hospitals by volume of racial and ethnic minority beneficiaries served. Multivariable logistic regression analysis was used compare surgical outcomes between hospitals serving high vs. low volumes of minority patients.

A total of 122,943 patients were included with racial composition of 360 (0.3%) American Indian or Native American, 2,077 (1.7%) Asian or Pacific Islander, 1,146(0.9%) Hispanic or Latino, 8,707(7.1%) non-Hispanic Black and 108,665(88.4%) non-Hispanic White. Overall, 31.6%, 15.9%, 15.0% and 7.8% of all hospitals performed 90% of lung cancer resection for Black, Asian, Hispanic, and Native American patients, respectively. Hospitals performing higher volumes of operations for racial and ethnic minorities had higher mortality(3.9% vs. 3.1%; OR 1.19, 95%CI 1.15-1.23; P<0.001), complications(18.1% vs. 15.9%; OR 1.17, 95%CI 1.14-1.19; P<0.001 and readmissions(11.7% vs. 11.2%; OR 1.04, 95%CI 1.02-1.05; P<0.001) for resection for lung cancer.

Our findings suggest that a small proportion of hospitals provide a disproportionate amount of surgical care for racial and ethnic minorities with lung cancer with inferior surgical outcomes.