The effect of race/ethnicity and insurance in the administration of standard therapy for local breast cancer in Florida

Lydia Voti, Lisa C. Richardson, Isildinha Reis, Lora E. Fleming, Jill MacKinnon, Jan Willem W. Coebergh

Research output: Contribution to journalArticle

45 Scopus citations

Abstract

Objectives. Assess the effect of race/ethnicity and insurance coverage on the receipt of standard treatment for local breast cancer. Methods. Local breast cancers diagnosed between July 1997 and December 2000 and reported to Florida's registry were linked to the Agency of Healthcare Administration inpatient and outpatient databases, resulting in 23,817 female local breast cancers with informative treatment. Standard treatment was defined as mastectomy or breast-conserving surgery followed by radiation therapy and it was modeled as a function of health insurance and race/ethnicity accounting for age at diagnosis, marital status and facility type. Results. Approximately 88% of the local breast cancers received standard treatment. The likelihood of standard treatment decreased by 3% per year of increase in the age at diagnosis. Compared to white non-Hispanic, black non-Hispanic women were 19% less likely to receive standard treatment (OR = 0.81, 95%CI = 0.68, 0.97) and Hispanics were 23% less likely (OR = 0.77, 95%CI = 0.66, 0.89). Local breast cancers diagnosed in non-teaching facilities were 21% more likely to receive standard treatment compared to those diagnosed in teaching facilities (OR = 1.21; 95%CI = 1.05, 1.38)). Compared to single, married women were 51% more likely to get standard treatment (OR = 1.51, 95%CI = 1.31, 1.75), followed by separated or divorced women that were 37% more likely (OR = 1.37, 95%CI = 1.13, 1.66). Compared to the privately insured, Medicare beneficiaries were 36% more likely to receive standard treatment (OR = 1.36, 95%CI = 1.22, 1.51) whereas the uninsured were 24% less likely (OR = 0.76, 95%CI = 0.59, 0.96); Medicaid insured women were 29% less likely to receive standard treatment compared to the privately insured (OR = 0.71, 95%CI = 0.53, 0.96). Conclusion. Future efforts should target the elderly, Hispanic and black women, the uninsured, and those on Medicaid in order to reduce treatment disparities.

Original languageEnglish (US)
Pages (from-to)89-95
Number of pages7
JournalBreast cancer research and treatment
Volume95
Issue number1
DOIs
StatePublished - Jan 1 2006

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Keywords

  • Health insurance
  • Local breast cancer
  • Patterns of care
  • Treatment disparities

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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