Better Colon Cancer Care for Extremely Poor Canadian Women Compared with American Women

Gorey, Kevin M.; Luginaah, Isaac; Bartfay, Emma; Zou, Guangyong; Haji-Jama, Sundus; Holowaty, Eric J.; Hamm, Caroline; Kanjeekal, Sindu M.; Wright, Frances C.; Balagurusamy, Madhan K; Richter, Nancy L.

doi:10.1093/hsw/hlt022

Cited by 18 publications

(21 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Consistent with findings from previous research, 14–20 having adequate health care insurance coverage predicted rates of OS while living in poverty and being a woman of color predicted rates of mortality. The women of color in our study were twice as likely to die within 7 years of being diagnosed with breast cancer than were non-Hispanic white women (HR = 2.28).…”

Section: Resultssupporting

confidence: 88%

See 1 more Smart Citation

Disparities among Minority Women with Breast Cancer Living in Impoverished Areas of California

et al. 2016

View full text Add to dashboard Cite

Background Interaction effects of poverty and health care insurance coverage on overall survival rates of breast cancer among women of color and non-Hispanic white women were explored. Methods We analyzed California registry data for 2,024 women of color (black, Hispanic, Asian, Pacific Islander, American Indian, or other ethnicity) and 4,276 non-Hispanic white women (Anglo-European ancestries and no Hispanic-Latin ethnic backgrounds) diagnosed with breast cancer between the years 1996 and 2000 who were then followed until 2011. The 2000 US census categorized rates of neighborhood poverty. Health care insurance coverage was either private, Medicare, Medicaid, or none. Cox regression was used to model rates of survival. Results A 3-way interaction between ethnicity, health care insurance coverage, and poverty was observed. Women of color inadequately insured and living in poor or near-poor neighborhoods in California were the most disadvantaged. Women of color adequately insured and who lived in such neighborhoods in California were also disadvantaged. The incomes of such women of color were typically lower than the incomes of non-Hispanic white women. Conclusions Women of color with or without insurance coverage are disadvantaged in poor and near-poor neighborhoods of California. Such women may be less able to bare the indirect, direct, or uncovered costs of health care for breast cancer treatment.

show abstract

Section: Resultssupporting

confidence: 88%

“…22–24 Based on previous analyses, primary health care insurance coverage was defined as adequate (private or Medicare) or inadequate (Medicaid or none). 15,16,18–20 …”

Section: Methodsmentioning

confidence: 99%

Disparities among Minority Women with Breast Cancer Living in Impoverished Areas of California

et al. 2016

View full text Add to dashboard Cite

show abstract

“…89 Similar to curative treatment barriers observed among those with non-metastasised colon cancer and consistent with this field’s synthetic evidence, 410–13 we and others have observed significant barriers to palliative chemotherapy among people living in poverty with metastasised colon cancer. 51415 Furthermore, our analyses found that prevalent health insurance inadequacies in America accounted for most, but not all of the poverty-based chemotherapy inadequacies, whether the intention was to cure or comfort. Our premise has been that focusing on the experiences of the most vulnerable people in the most vulnerable places magnifies clinical, policy and human significance.…”

Section: Introductionmentioning

confidence: 71%

Palliative chemotherapy among people living in poverty with metastasised colon cancer: facilitation by primary care and health insurance

Gorey

Bartfay

Kanjeekal

et al. 2016

BMJ Support Palliat Care

View full text Add to dashboard Cite

Background Many Americans with metastasised colon cancer do not receive indicated palliative chemotherapy. We examined the effects of health insurance and physician supplies on such chemotherapy in California. Methods We analysed registry data for 1199 people with metastasised colon cancer diagnosed between 1996 and 2000 and followed for 1 year. We obtained data on health insurance, census tract-based socioeconomic status and county-level physician supplies. Poor neighbourhoods were oversampled and the criterion was receipt of chemotherapy. Effects were described with rate ratios (RR) and tested with logistic regression models. Results Palliative chemotherapy was received by less than half of the participants (45%). Facilitating effects of primary care (RR=1.23) and health insurance (RR=1.14) as well as an impeding effect of specialised care (RR=0.86) were observed. Primary care physician (PCP) supply took precedence. Adjusting for poverty, PCP supply was the only significant and strong predictor of chemotherapy (OR=1.62, 95% CI 1.02 to 2.56). The threshold for this primary care advantage was realised in communities with 8.5 or more PCPs per 10 000 inhabitants. Only 10% of participants lived in such well-supplied communities. Conclusions This study’s observations of facilitating effects of primary care and health insurance on palliative chemotherapy for metastasised colon cancer clearly suggested a way to maximise Affordable Care Act (ACA) protections. Strengthening America’s system of primary care will probably be the best way to ensure that the ACA’s full benefits are realised. Such would go a long way towards facilitating access to palliative care.

show abstract

“…Standardized rate ratios (RR) and rate differences (RD) were reported with 95% confidence intervals (CI). Further methodological details were published (Gorey et al, 2011(Gorey et al, , 2013. …”

mentioning

confidence: 99%

“…Colon cancer care, a common and treatable form of cancer, was studied among those living in poverty in 1990s and 2000s California (Gorey et al, 2011(Gorey et al, , 2013. Similar people were originally studied in Ontario.…”

mentioning

confidence: 99%

Profound barriers to basic cancer care most notably experienced by uninsured women: Historical note on the present policy considerations

Alberton

Gorey

2017

Social Work in Health Care

View full text Add to dashboard Cite

America is considering the replacement of Obamacare with Trumpcare. This historical cohort revisited pre-Obamacare colon cancer care among people living in poverty in California (N = 5,776). It affirmed a gender by health insurance hypothesis on nonreceipt of surgery such that uninsured women were at greater risk than uninsured men. Uninsured women were three times as likely as insured women to be denied access to such basic care. Similar men were two times as likely. America is bound to repeat such profound health care inequities if Obamacare is repealed. Instead, Obamacare ought to be retained and strengthened in all states, red and blue. KeywordsColon cancer care; gender; health care policy; health care reform; historical cohort; intersectionality; interaction effect; Patient Protection and Affordable Care Act; structural inequality; uninsured Various health care acts or Trumpcare are being considered to replace the Affordable Care Act (ACA) or Obamacare. If any pass they would increase the ranks of the uninsured and decrease the benefits of all, but the wealthiest Americans while increasing their out-ofpocket costs. People living in poverty would suffer the most, especially the Medicaideligible or near-eligible in so-called red states. Our profession has a tradition of advocating for quality health care for all and we are again called to action (Gorin, 2017; National Association of Social Workers, 2009). This study revisits pre-Obamacare cancer care and reminds us of the profound barriers to basic care that were experienced by uninsured people, especially women in the USA.Canada and the USA share a 5,000 kilometer border and many social and economic characteristics, but provide health care in distinct ways. Canada provides universal access to care via a single, public payer, while the USA provides no such guarantee via multiple , 1997). It tended to mute enthusiasm for Canada-like solutions to America's health care problems as it found no practical survival differences between the two countries. Otherwise well designed, it did not account for socioeconomic factors. Our research group thought such comparisons of national "haystacks" tended to lose important "needles" of knowledge. Consider the diversity of people and places in Canada and the USA: women and men, uninsured to well-insured, residing in high poverty to affluent neighborhoods and so on. Overall comparisons of the average effects of countries are bound to miss knowledge about the unique experiences of important subpopulations. We studied breast and colon cancer care in impoverished places in Ontario and California over the past two decades and observed large Canadian advantages on treatment access and survival. In fact, the more impoverished the people or places the larger were the Canadian advantages that were largely explained by their better health insurance coverage (Gorey, Hamm, Luginaah, Zou, & Holowaty, 2017;Gorey et al., 1997).Focusing on the experiences of socioeconomically vulnerable people in vulnerable places seems to magnify...

show abstract

Better Colon Cancer Care for Extremely Poor Canadian Women Compared with American Women

Cited by 18 publications

References 34 publications

Disparities among Minority Women with Breast Cancer Living in Impoverished Areas of California

Disparities among Minority Women with Breast Cancer Living in Impoverished Areas of California

Palliative chemotherapy among people living in poverty with metastasised colon cancer: facilitation by primary care and health insurance

Profound barriers to basic cancer care most notably experienced by uninsured women: Historical note on the present policy considerations

Contact Info

Product

Resources

About