The association of race/ethnicity, insurance status, and socioeconomic factors with breast cancer care

• Published in: Cancer 2011-01, Vol.117 (1), p.180-189
• Main Authors: Freedman, Rachel A., Virgo, Katherine S., He, Yulei, Pavluck, Alexandre L., Winer, Eric P., Ward, Elizabeth M., Keating, Nancy L.
• Format: Article
• Language: English
• Subjects: Adult; African Continental Ancestry Group; Aged; Aged, 80 and over; Biological and medical sciences; breast cancer; Breast Neoplasms - economics; Breast Neoplasms - ethnology; Breast Neoplasms - therapy; Chemotherapy, Adjuvant; Combined Modality Therapy; Continental Population Groups; disparity; Ethnic Groups; European Continental Ancestry Group; Female; Gynecology. Andrology. Obstetrics; Healthcare Disparities; Hispanic Americans; Hormones - therapeutic use; Humans; insurance; Insurance Coverage; Insurance, Health; Mammary gland diseases; Mastectomy; Medical sciences; race; Radiotherapy, Adjuvant; Social Class; Socioeconomic Factors; socioeconomic status; Tumors
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.25542

BACKGROUND: Few data are available on how race/ethnicity, insurance, and socioeconomic status (SES) interrelate to influence breast cancer treatment. The authors examined care for a national cohort of breast cancer patients to assess whether insurance and SES were associated with racial/ethnic differences in care. METHODS: The authors used multivariate logistic regression to assess the probability of definitive locoregional therapy, hormone receptor testing, and adjuvant systemic therapy among 662,117 white, black, and Hispanic women diagnosed with invasive breast cancer during 1998‐2005 at National Cancer Data Base hospitals. In additional models, the authors included insurance and area‐level SES to determine whether these variables were associated with observed racial/ethnic disparities. RESULTS: Most women were white (86%), 10% were black, and 4% were Hispanic. Most had private insurance (51%) or Medicare (41%). Among eligible patients, 80.0% (stage I/II) had definitive locoregional therapy, 98.5% (stage I‐IV) had hormone receptor testing, and 53.1% and 50.2% (stage I‐III) received adjuvant hormonal therapy and chemotherapy, respectively. After adjustment, black (vs white) women had less definitive locoregional therapy (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.88‐0.94), hormonal therapy (OR, 0.90; 95% CI, 0.87‐0.93), and chemotherapy (OR, 0.87; 95% CI, 0.84‐0.91). Hispanic (vs white) women were also less likely to receive hormonal therapy. Hormone receptor testing did not differ by race/ethnicity. Racial disparities persisted despite adjusting for insurance and SES. CONCLUSIONS: The modest association between black (vs white) race and guideline‐recommended breast cancer care was insensitive to adjustment for insurance and area‐level SES. Further study is required to better understand disparities and to ensure receipt of care. Cancer 2011. © 2010 American Cancer Society. The authors observed that black women had modestly lower rates of guideline‐recommended breast cancer care compared with white women. The lower rates in receipt of care were insensitive to adjustment for insurance and area‐level socioeconomic status.