Socioeconomic Disparities in Mortality Among Women With Incident Breast Cancer Before and After Implementation of Medicare Part D

Abstract

Background Breast cancer patients exhibit survival disparities based on socioeconomic status (SES). Disparities may be attributable to access to expensive oral endocrine agents. Objectives Define recent socioeconomic disparities in breast cancer survival and determine whether these improved after implementation of the Medicare Part D program. Design Difference-in-difference natural experiment of women diagnosed and treated before or after implementation of Medicare Part D. Subjects Female Medicare beneficiaries with early stage breast cancer: 54,772 diagnosed in 2001 and 46,371 in 2007. Measures SES was based on Medicaid enrollment and zip code per capita income, all-cause mortality from Medicare, and cause of death from National Death Index. Results Among women diagnosed pre-Part D, 40.5% of poor beneficiaries had died within 5 years compared to 20.3% of high-income women (p<0.0001). Post-Part D, 33.6% of poor women and 18.4% of high-income women died by 5 years. After adjustment for potential confounders, improvement in all-cause mortality post-Part D was greater for poorer women compared to more affluent women (p=0.002). However, absolute improvement in breast cancer-specific mortality was 1.8%, 1.2%, and 0.8% (p=0.88 for difference in improvement by SES) respectively for poor, near poor, and high-income women, while analogous improvement in mortality from other causes was 5.1%, 3.8% and 0.9% (p=0.067 for difference in improvement by SES). Conclusions Large survival disparities by SES exist among breast cancer patients. The Part D program successfully ameliorated SES disparities in all-cause mortality. However, improvement was concentrated in causes of death other than breast cancer, suggesting remaining gaps in care.

Housing discrimination and racial cancer disparities among the 100 largest US metropolitan areas

“…Much of the existing literature on racial disparities focuses on poorer survival among racial groups once the cancer is diagnosed, with less focus on incidence or prevention (other than tobacco reduction). 18,19 Our findings suggest that cancer incidence, mortality, and survival disparities warrant attention. Cancer November 1, 2019 There are plausible mechanisms by which mortgage discrimination might cause greater cancer incidence or poorer survival among blacks.…”

“…18 The relationship between mortgage discrimination and cancer mortality disparities is attenuated, but not eliminated, when adjusting for incidence disparities, suggesting that both incidence and survival are factors relevant to the relationship between mortgage discrimination and cancer mortality disparities. In MSAs with higher levels of mortgage discrimination, blacks are at a greater cancer mortality disadvantage compared with whites.…”

“…This relationship persists when adjusting for socioeconomic factors known to be related to breast cancer mortality disparities. 18 The relationship between mortgage discrimination and cancer mortality disparities is attenuated, but not eliminated, when adjusting for incidence disparities, suggesting that both incidence and survival are factors relevant to the relationship between mortgage discrimination and cancer mortality disparities. Measures of segregation are inconsistently associated with cancer disparities, although black men living in areas with greater isolation experience significantly greater cancer incidence and mortality.…”

Geo-economic variations in epidemiology, patterns of care, and outcomes in patients with acute respiratory distress syndrome: insights from the LUNG SAFE prospective cohort study

“…Studies have shown the disadvantages of low socioeconomic status on outcomes from diverse major medical conditions such as diabetes, 7 asthma, 33 acute myocardial infarction, 34 and breast cancer. 35 These data collectively represent a substantial public health challenge, and future studies are needed to elucidate the mechanisms by which differences in socioeconomic status mediate differences in outcomes, so that targeted interventions can be designed and assessed.…”

Mapping mammography in Arkansas: Locating areas with poor spatial access to breast cancer screening using optimization models and geographic information systems

“…In particular, health disparity populations of Blacks/African Americans, low-income populations, and rural populations tend to have low utilization rates [4][5][6]. Low screening utilization in turn translates into delayed diagnosis and decreased survival rates [7][8][9][10][11]. Curtis et al found that differences in screening behaviors accounted for a considerable portion of mortality differences between populations [12].…”