Racial and socio-economic disparities in breast cancer hospitalization outcomes by insurance status

Abstract

Background Breast cancer remains a major cause of morbidity and mortality among women in the US, and despite numerous studies documenting racial disparities in outcomes, the survival difference between Black and White women diagnosed with breast cancer continues to widen. Few studies have assessed whether observed racial disparities in outcomes vary by insurance type e.g. Medicare/Medicaid versus private insurance. Differences in coverage, availability of networked physicians, or cost-sharing policies may influence choice of treatment and treatment outcomes, even after patients have been hospitalized, effects of which may be differential by race. Purpose The aim of this analysis was to examine hospitalization outcomes among patients with a primary diagnosis of breast cancer and assess whether differences in outcome exist by insurance status after adjusting for age, race/ethnicity and socio-economic status. Methods We obtained data on over 67,000 breast cancer patients with a primary diagnosis of breast cancer for this cross-sectional study from the 2007-2011 Healthcare Cost and Utilization project Nationwide Inpatient Sample (HCUP-NIS), and examined breast cancer surgery type (mastectomy vs. breast conserving surgery or BCS), post-surgical complications and in-hospital mortality. Multivariable regression models were used to compute estimates, odds ratios and 95% confidence intervals. Results Black patients were less likely to receive mastectomies compared with White women (OR: 0.80, 95% CI: 0.71 - 0.90), regardless of whether they had Medicare/Medicaid or Private insurance. Black patients were also more likely to experience post-surgical complications (OR: 1.41, 95% CI: 1.12-1.78) and higher in-hospital mortality (OR: 1.57, 95%: 1.21-2.03) compared with White patients, associations that were strongest among women with Private insurance. Women residing outside of large metropolitan areas were significantly more likely to receive mastectomies (OR: 1.89, 95% CI: 1.54-2.31) and experience higher in-hospital mortality (OR: 1.74, 95% CI: 1.40-2.16) compared with those in metropolitan areas, regardless of insurance type. Conclusion Among hospitalized patients with breast cancer, racial differences in hospitalization outcomes existed and worse outcomes were observed among Black women with private insurance. Future studies are needed to determine factors associated with poor outcomes in this group of women, as well as to examine contributors to low BCS adoption in non-metropolitan areas.

Impact of acculturation on breast cancer treatment and survivorship care among Mexican American patients in Texas

“…In the univariable analysis, patient characteristics that were significantly associated with receipt of BCS (compared to mastectomy) included age ( P = .003), education ( P = .005), and stage at diagnosis ( P < .001). Although insurance status and area of residence were not significant in the univariate analyses, we retained these variables in the final model because they can be associated with the type of surgery patients receive [37, 38]. In the adjusted multivariable analysis, bilingual women (odds ratio [OR] = 1.85; 95% confidence interval [CI] = 0.85–4.02; P = .11) and English-dominant women (OR = 2.39; 95% CI = 1.02–5.61; P = .04) had higher odds of receiving BCS than did Spanish-dominant women (Table 2).…”

Safety‐net versus private hospital setting for brain metastasis patients treated with radiosurgery alone: Disparities in follow‐up care and outcomes

“…Unfortunately, not all patients have equal access to recommended follow‐up clinical care, neuroimaging, and salvage treatment. Disparities in access to cancer care among different racial and socioeconomic groups are well recognized in the medical literature . The effect of disparities in access to care on patient outcomes is unknown when a strategy of treating brain metastases with SRS alone is used.…”

“…Disparities in access to cancer care among different racial and socioeconomic groups are well recognized in the medical literature. [6][7][8][9][10][11][12][13] The effect of disparities in access to care on patient outcomes is unknown when a strategy of treating brain metastases with SRS alone is used. We compared clinical outcomes between safety-net hospital (SNH) and private hospital (PH) patients treated with SRS alone to test the hypothesis that, because of worse neurologic outcomes, SRS alone with observation may not always be suitable for patients originating from an SNH environment who may have barriers to appropriate follow-up care.…”

The site of care matters: An examination of the relationship between high Medicaid burden hospitals and the use, cost, and complications of immediate breast reconstruction after mastectomy

“…1,3,4 This is important because IBR offers clear psychosocial benefits to recipients (eg, improved body image and self-esteem). 1,3,4 This is important because IBR offers clear psychosocial benefits to recipients (eg, improved body image and self-esteem).…”

“…In recent years, Medicaid insurance status has been identified as an independent risk factor for diminished access to immediate breast reconstruction (IBR) 1,2 and poor outcomes after mastectomy. 1,3,4 This is important because IBR offers clear psychosocial benefits to recipients (eg, improved body image and self-esteem). 5,6 These issues also have considerable health policy salience because: 1) Medicaid currently is the largest health insurance program, by enrollment, in the United States 7 ; and 2) Medicaid expansion was one of the principal vectors for increasing insurance coverage under the Patient Protection and Affordable Care Act.…”