Differences in the quality of breast cancer care among vulnerable populations

David Haggstrom, Chris Quale, Rebecca Smith-Bindman

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

BACKGROUND. It is unknown whether differences in the quality of breast cancer care among women from racial and ethnic minority groups, the elderly, and rural areas have changed over time across the continuum of care. METHODS. The linked Surveillance, Epidemiology, and End Results-Medicare database identified 22,701 women ages 66-79 years diagnosed with early stage breast cancer from 1992-1999. Multiple breast cancer processes of care were measured, including breast-conserving surgery, radiation therapy, documentation of estrogen receptor status, surveillance mammography, and a combined measure of "adequate care". RESULTS. African-American and Hispanic women were significantly less likely to receive adequate care than White women in unadjusted comparisons (54.7% and 58.0% vs. 68.4% for African-American and Hispanic vs. White women) and adjusted comparisons (adjusted odds ratio [AOR] 0.67; 95% confidence interval [95% CI] 0.59-0.76, and AOR 0.77; 95% CI 0.66-0.90 for African-American and Hispanic women, respectively). The proportion of Asian/Pacific Islander women receiving adequate care was similar to White women. When considering only women diagnosed with breast cancer from 1997-1999, African-American women remained less likely than White women to receive adequate care (AOR 0.63; 95% CI 0.50-0.79). Women ages 75-79 years were less likely to receive adequate care compared with women ages 66-69 years (AOR 0.74; 95% CI 0.69-0.80), and women from rural (vs. metropolitan) areas were less likely to receive adequate care (AOR 0.81; 95% CI 0.73-0.89). CONCLUSIONS. The quality of breast cancer care is lower among vulnerable populations across the continuum of care, and many of these differences have not improved in more recent years.

Original languageEnglish (US)
Pages (from-to)2347-2358
Number of pages12
JournalCancer
Volume104
Issue number11
DOIs
StatePublished - Dec 1 2005
Externally publishedYes

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Vulnerable Populations
Breast Neoplasms
African Americans
Odds Ratio
Confidence Intervals
Hispanic Americans
Continuity of Patient Care
Minority Groups
Segmental Mastectomy
Mammography
Medicare
Ethnic Groups
Estrogen Receptors
Documentation
Epidemiology
Radiotherapy

Keywords

  • African Americans
  • Asian Americans
  • Breast cancer
  • Hispanic Americans
  • Physician's practice patterns
  • Therapy
  • Women's health

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Differences in the quality of breast cancer care among vulnerable populations. / Haggstrom, David; Quale, Chris; Smith-Bindman, Rebecca.

In: Cancer, Vol. 104, No. 11, 01.12.2005, p. 2347-2358.

Research output: Contribution to journalArticle

Haggstrom, David ; Quale, Chris ; Smith-Bindman, Rebecca. / Differences in the quality of breast cancer care among vulnerable populations. In: Cancer. 2005 ; Vol. 104, No. 11. pp. 2347-2358.
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N2 - BACKGROUND. It is unknown whether differences in the quality of breast cancer care among women from racial and ethnic minority groups, the elderly, and rural areas have changed over time across the continuum of care. METHODS. The linked Surveillance, Epidemiology, and End Results-Medicare database identified 22,701 women ages 66-79 years diagnosed with early stage breast cancer from 1992-1999. Multiple breast cancer processes of care were measured, including breast-conserving surgery, radiation therapy, documentation of estrogen receptor status, surveillance mammography, and a combined measure of "adequate care". RESULTS. African-American and Hispanic women were significantly less likely to receive adequate care than White women in unadjusted comparisons (54.7% and 58.0% vs. 68.4% for African-American and Hispanic vs. White women) and adjusted comparisons (adjusted odds ratio [AOR] 0.67; 95% confidence interval [95% CI] 0.59-0.76, and AOR 0.77; 95% CI 0.66-0.90 for African-American and Hispanic women, respectively). The proportion of Asian/Pacific Islander women receiving adequate care was similar to White women. When considering only women diagnosed with breast cancer from 1997-1999, African-American women remained less likely than White women to receive adequate care (AOR 0.63; 95% CI 0.50-0.79). Women ages 75-79 years were less likely to receive adequate care compared with women ages 66-69 years (AOR 0.74; 95% CI 0.69-0.80), and women from rural (vs. metropolitan) areas were less likely to receive adequate care (AOR 0.81; 95% CI 0.73-0.89). CONCLUSIONS. The quality of breast cancer care is lower among vulnerable populations across the continuum of care, and many of these differences have not improved in more recent years.

AB - BACKGROUND. It is unknown whether differences in the quality of breast cancer care among women from racial and ethnic minority groups, the elderly, and rural areas have changed over time across the continuum of care. METHODS. The linked Surveillance, Epidemiology, and End Results-Medicare database identified 22,701 women ages 66-79 years diagnosed with early stage breast cancer from 1992-1999. Multiple breast cancer processes of care were measured, including breast-conserving surgery, radiation therapy, documentation of estrogen receptor status, surveillance mammography, and a combined measure of "adequate care". RESULTS. African-American and Hispanic women were significantly less likely to receive adequate care than White women in unadjusted comparisons (54.7% and 58.0% vs. 68.4% for African-American and Hispanic vs. White women) and adjusted comparisons (adjusted odds ratio [AOR] 0.67; 95% confidence interval [95% CI] 0.59-0.76, and AOR 0.77; 95% CI 0.66-0.90 for African-American and Hispanic women, respectively). The proportion of Asian/Pacific Islander women receiving adequate care was similar to White women. When considering only women diagnosed with breast cancer from 1997-1999, African-American women remained less likely than White women to receive adequate care (AOR 0.63; 95% CI 0.50-0.79). Women ages 75-79 years were less likely to receive adequate care compared with women ages 66-69 years (AOR 0.74; 95% CI 0.69-0.80), and women from rural (vs. metropolitan) areas were less likely to receive adequate care (AOR 0.81; 95% CI 0.73-0.89). CONCLUSIONS. The quality of breast cancer care is lower among vulnerable populations across the continuum of care, and many of these differences have not improved in more recent years.

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KW - Physician's practice patterns

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