Increased racial differences on breast cancer care and survival in America: historical evidence consistent with a health insurance hypothesis, 1975–2001

Gorey, Kevin M.; Luginaah, Isaac; Schwartz, Kendra; Fung, Karen Y.; Balagurusamy, Madhan K; Bartfay, Emma; Wright, Frances C.; Anucha, Uzoamaka; Parsons, Renee R.

doi:10.1007/s10549-008-9960-1

Cited by 13 publications

(9 citation statements)

References 53 publications

(33 reference statements)

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“…International studies have allowed us to develop the theory that SES-cancer care relationships are probably mediated by health insurance [2,25-27]. It is also probable that within the multi-payer US health care system the effects of various health insurers interact with other resources in ways not yet studied.…”

Section: Introductionmentioning

confidence: 99%

Mediation of the effects of living in extremely poor neighborhoods by health insurance: breast cancer care and survival in California, 1996 to 2011

Gorey

Luginaah

Holowaty

et al. 2013

International Journal for Equity in Health

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BackgroundWe examined the mediating effect of health insurance on poverty-breast cancer care and survival relationships and the moderating effect of poverty on health insurance-breast cancer care and survival relationships in California.MethodsRegistry data for 6,300 women with breast cancer diagnosed between 1996 and 2000 and followed until 2011 on stage at diagnosis, surgeries, adjuvant treatments and survival were analyzed. Socioeconomic data were obtained for residences from the 2000 census to categorize neighborhoods: high poverty (30% or more poor), middle poverty (5%-29% poor) and low poverty (less than 5% poor). Primary payers or health insurers were Medicaid, Medicare, private or uninsured.ResultsEvidence of survival mediation was observed for women with node negative breast cancer. The apparent effect of poverty disappeared in the presence of Medicare or private health insurance. Women who were so insured were advantaged on 8-year survival compared to the uninsured or those insured by Medicaid (OR = 1.89). Evidence of payer moderation by poverty was also observed for women with node negative breast cancer. The survival advantaging effect of Medicare or private insurance was stronger in low poverty (OR = 1.81) than it was in middle poverty (OR = 1.57) or in high poverty neighborhoods (OR = 1.16). This same pattern of mediated and moderated effects was also observed for early stage at diagnosis, shorter waits for adjuvant radiation therapy and for the receipt of sentinel lymph node biopsies. These findings are consistent with the theory that more facilitative social and economic capital is available in low poverty neighborhoods, where women with breast cancer may be better able to absorb the indirect and direct, but uncovered, costs of care. As for treatments, main protective effects as well as moderator effects indicative of protection, particularly in high poverty neighborhoods were observed for women with private health insurance.ConclusionsAmerica’s multi-tiered health insurance system mediates the quality of breast cancer care. The system is inequitable and unjust as it advantages the well insured and the well to do. Recent health care reforms ought to be enacted in ways that are consistent with their federal legislative intent, that high quality health care be truly available to all.

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Section: Introductionmentioning

confidence: 99%

Mediation of the effects of living in extremely poor neighborhoods by health insurance: breast cancer care and survival in California, 1996 to 2011

Gorey

Luginaah

Holowaty

et al. 2013

International Journal for Equity in Health

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“…Our previous within-US and Canada-US comparative studies of cancer care have allowed us to develop the theory that SES-cancer care relationships are probably mediated by health insurance [9,13,37]. We think that it is also probable that within the multi-payer US health care system the effects of various payers (self, Medicaid, Medicare and/or various private insurance companies) interact with other socioeconomic resources, personal and community, in complex ways that have not yet been studied.…”

Section: Introductionmentioning

confidence: 99%

Effects of being uninsured or underinsured and living in extremely poor neighborhoods on colon cancer care and survival in California: historical cohort analysis, 1996—2011

et al. 2012

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BackgroundWe examined the mediating effects of health insurance on poverty-colon cancer care and survival relationships and the moderating effects of poverty on health insurance-colon cancer care and survival relationships among women and men in California.MethodsWe analyzed registry data for 3,291 women and 3,009 men diagnosed with colon cancer between 1996 and 2000 and followed until 2011 on lymph node investigation, stage at diagnosis, surgery, chemotherapy, wait times and survival. We obtained socioeconomic data for individual residences from the 2000 census to categorize the following neighborhoods: high poverty (30% or more poor), middle poverty (5-29% poor) and low poverty (less than 5% poor). Primary health insurers were Medicaid, Medicare, private or none.ResultsEvidence of mediation was observed for women, but not for men. For women, the apparent effect of poverty disappeared in the presence of payer, and the effects of all forms of health insurance seemed strengthened. All were advantaged on 6-year survival compared to the uninsured: Medicaid (RR = 1.83), Medicare (RR = 1.92) and private (RR = 1.83). Evidence of moderation was also only observed for women. The effects of all forms of health insurance were stronger for women in low poverty neighborhoods: Medicaid (RR = 2.90), Medicare (RR = 2.91) and private (RR = 2.60). For men, only main effects of poverty and payers were observed, the advantaging effect of private insurance being largest. Across colon cancer care processes, Medicare seemed most instrumental for women, private payers for men.ConclusionsHealth insurance substantially mediates the quality of colon cancer care and poverty seems to make the effects of being uninsured or underinsured even worse, especially among women in the United States. These findings are consistent with the theory that more facilitative social and economic capital is available in more affluent neighborhoods, where women with colon cancer may be better able to absorb the indirect and direct, but uncovered, costs of care.

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“…Studies of men with prostate cancer and women with breast cancer suggest that Caucasians and AAs seemed to have received comparable treatments (45–50). However, AAs seem to be less likely than Caucasians to undergo surgery for early-stage lung cancer (51), coronary revascularization procedures (52, 53), breast cancer screening (54–56), and renal transplantation (57). Non–guideline-concordant adjuvant chemotherapy regimens were more frequently used in AA women, which might contribute to less favorable outcomes in these populations (58).…”

Section: Discussionmentioning

confidence: 99%

Impact of High-Dose Chemotherapy on the Ability to Deliver Subsequent Local–Regional Radiotherapy for Breast Cancer: Analysis of Cancer and Leukemia Group B Protocol 9082

Marks

Cirrincione

Fitzgerald

et al. 2010

International Journal of Radiation Oncology*Biology*Physics

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Purpose-To report, from Cancer and Leukemia Group B Protocol 9082, the impact of highdose cyclophosphamide, cisplatin, and BCNU (HD-CPB) vs. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript the ability to start and complete the planned course of local-regional radiotherapy (RT) for women with breast cancer involving ≥10 axillary nodes.Methods and Materials-From 1991 to 1998, 785 patients were randomized. The HD-CPB and ID-CPB arms were balanced regarding patient characteristics. The HD-CPB and ID-CPB arms were compared on the probability of RT initiation, interruption, modification, or incompleteness. The impact of clinical variables and interactions between variables were also assessed. Conclusion-Treatment arm significantly related to initiation, interruption, modification, and early termination of RT. Patients randomized to HD-CPB were less likely to initiate RT, and of those who did, they were more likely to have RT interrupted, modified, and terminated earlier than those randomized to ID-CPB. The observed lower incidence of RT usage in African Americans vs. non-African Americans warrants further study. Results-Radiotherapy

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Increased racial differences on breast cancer care and survival in America: historical evidence consistent with a health insurance hypothesis, 1975–2001

Cited by 13 publications

References 53 publications

Mediation of the effects of living in extremely poor neighborhoods by health insurance: breast cancer care and survival in California, 1996 to 2011

Mediation of the effects of living in extremely poor neighborhoods by health insurance: breast cancer care and survival in California, 1996 to 2011

Effects of being uninsured or underinsured and living in extremely poor neighborhoods on colon cancer care and survival in California: historical cohort analysis, 1996—2011

Impact of High-Dose Chemotherapy on the Ability to Deliver Subsequent Local–Regional Radiotherapy for Breast Cancer: Analysis of Cancer and Leukemia Group B Protocol 9082

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