Effects of health insurance and race on breast carcinoma treatments and outcomes

Cancer. 2000 Dec 1;89(11):2202-13. doi: 10.1002/1097-0142(20001201)89:11<2202::aid-cncr8>3.0.co;2-l.

Abstract

Background: The authors hypothesized that insurance payer and race would influence the care and outcomes for patients with breast carcinoma.

Methods: The authors examined treatments and adjusted risk of death (through 1997) for all incident cases of breast carcinoma occurring in Florida in 1994 (n = 11,113) by using state tumor registry data.

Results: Patients lacking health insurance were less likely to receive breast-conserving surgery (BCS) compared with patients who had private health insurance. Among patients insured by Medicare, those belonging to a health maintenance organization (HMO) were more likely to receive BCS but less likely to receive radiation therapy after BCS. Non-Hispanic African Americans had higher mortality rates even when stage at diagnosis, insurance payer, and treatment modalities used were adjusted in multivariate models (adjusted risk ratio [RR], 1.35; 95% confidence interval [CI], 1.12-1.61; P = 0.001). Patients who had HMO insurance had similar survival rates compared with those with fee-for-service (FFS) insurance. Among non-Medicare patients, mortality rates were higher for patients who had Medicaid insurance (RR, 1.58, 95% CI, 1.18-2.11; P = 0.002) and those who lacked health insurance (RR, 1.31; 95% CI, 1.03-1.68; P = 0.03) compared with patients who had commercial FFS insurance. There were no insurance-related differences in survival rates, however, once stage at diagnosis was controlled.

Conclusions: As a result of later stage at diagnosis, patients with breast carcinoma who were uninsured, or insured by Medicaid, had higher mortality rates. Mortality rates were also higher among non-Hispanic African Americans, a finding that was not fully explained by differences in stage at diagnosis, treatment modalities used, or insurance payer.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • African Americans
  • African Continental Ancestry Group*
  • Breast Neoplasms / ethnology
  • Breast Neoplasms / mortality*
  • Breast Neoplasms / therapy*
  • European Continental Ancestry Group*
  • Female
  • Florida / epidemiology
  • Hispanic Americans
  • Humans
  • Insurance, Health*
  • Mastectomy, Segmental / statistics & numerical data
  • Middle Aged
  • Multivariate Analysis
  • Patient Acceptance of Health Care
  • Proportional Hazards Models
  • Registries
  • Survival Rate