医院层面的因素，例如医院类型或规模，已被证明在黑人癌症患者的治疗差异中发挥着作用。然而，缺乏评估医院认证状态与黑人癌症患者治疗差异之间关系的数据。 评估癌症委员会 (CoC) 医院认证状态与非西班牙裔黑人接受指南一致护理和死亡率之间的关系这项基于人群的队列研究使用了国家癌症登记计划，这是一个多中心数据库，包含来自所有 50 个州和哥伦比亚特区的数据，覆盖了美国 97% 的癌症人口。参与者包括 2018 年 1 月 1 日至 2020 年 12 月 31 日期间被诊断患有结肠癌的 18 岁或以上的非西班牙裔黑人患者。种族和民族是从医疗保健机构和从业人员记录的医疗记录中提取的。数据分析时间为2023年12月7日至2024年1月17日。CoC医院认证。指南一致护理的定义是对I至III期疾病患者进行充分的淋巴结切除术，或对III期疾病患者进行化疗。多变量逻辑回归模型研究了与接受指南一致护理的关联性，Cox 比例风险回归模型评估了与 3 年癌症特异性死亡率的关联性。 在 17249 名患有结肠癌的非西班牙裔黑人患者中（平均 [SD] 年龄为 64.8 [ 12.8] 岁；8724 名女性 [50.6%]），其中 12756 名（74.0%；平均 [SD] 年龄，64.7 [12.8] 岁）在 CoC 认可的医院接受治疗，4493 名（26.0%；平均 [SD] 年龄， 65.1 [12.5] 年）在非 CoC 认证的医院。与在非 CoC 认证医院治疗的患者相比，在 CoC 认可的医院接受治疗的患者接受符合指南的淋巴结切除术（调整后比值比 [AOR]，1.89；95% CI，1.69-2.11）和化疗（AOR， 2.31；95% CI，1.97-2.72）。对于接受手术的 I 至 III 期疾病患者（调整后的风险比 [AHR]，0.87；95% CI，0.76-0.98）和 III 期疾病患者，在 CoC 认可的医院进行治疗与较低的癌症特异性死亡率相关符合化疗条件（AHR，0.75；95% CI，0.59-0.96）。 在这项针对非西班牙裔黑人结肠癌患者的队列研究中，在 CoC 认可的医院接受治疗的患者与在非 CoC 认可的医院接受治疗的患者相比，更有可能接受符合指南的护理并且死亡风险较低。这些发现表明，增加在 CoC 认可的医院获得符合指南的高质量护理的机会可能会减少服务不足人群的癌症治疗和结果的差异。

Hospital-level factors, such as hospital type or volume, have been demonstrated to play a role in treatment disparities for Black patients with cancer. However, data evaluating the association of hospital accreditation status with differences in treatment among Black patients with cancer are lacking.To evaluate the association of Commission on Cancer (CoC) hospital accreditation status with receipt of guideline-concordant care and mortality among non-Hispanic Black patients with colon cancer.This population-based cohort study used the National Program of Cancer Registries, which is a multicenter database with data from all 50 states and the District of Columbia, and covers 97% of the cancer population in the US. The participants included non-Hispanic Black patients aged 18 years or older diagnosed with colon cancer between January 1, 2018, and December 31, 2020. Race and ethnicity were abstracted from medical records as recorded by health care facilities and practitioners. The data were analyzed from December 7, 2023, to January 17, 2024.CoC hospital accreditation.Guideline-concordant care was defined as adequate lymphadenectomy during surgery for patients with stages I to III disease or chemotherapy administration for patients with stage III disease. Multivariable logistic regression models investigated associations with receipt of guideline-concordant care and Cox proportional hazards regression models assessed associations with 3-year cancer-specific mortality.Of 17 249 non-Hispanic Black patients with colon cancer (mean [SD] age, 64.8 [12.8] years; 8724 females [50.6%]), 12 756 (74.0%; mean [SD] age, 64.7 [12.8] years) were treated at a CoC-accredited hospital and 4493 (26.0%; mean [SD] age, 65.1 [12.5] years) at a non-CoC-accredited hospital. Patients treated at CoC-accredited hospitals compared with those treated at non-CoC-accredited hospitals had higher odds of receiving guideline-concordant lymphadenectomy (adjusted odds ratio [AOR], 1.89; 95% CI, 1.69-2.11) and chemotherapy (AOR, 2.31; 95% CI, 1.97-2.72). Treatment at CoC-accredited hospitals was associated with lower cancer-specific mortality for patients with stages I to III disease who received surgery (adjusted hazard ratio [AHR], 0.87; 95% CI, 0.76-0.98) and for patients with stage III disease eligible for chemotherapy (AHR, 0.75; 95% CI, 0.59-0.96).In this cohort study of non-Hispanic Black patients with colon cancer, patients treated at CoC-accredited hospitals compared with those treated at non-CoC-accredited hospitals were more likely to receive guideline-concordant care and have lower mortality risk. These findings suggest that increasing access to high-quality guideline-concordant care at CoC-accredited hospitals may reduce variations in cancer treatment and outcomes for underserved populations.