Racial differences in definitive breast cancer therapy in older women: are they explained by the hospitals where patients undergo surgery?

Med Care. 2009 Jul;47(7):765-73. doi: 10.1097/MLR.0b013e31819e1fe7.

Abstract

Background: Prior research has documented racial disparities in patterns of care and outcomes for women with breast cancer.

Objectives: To assess whether black women receive care from lower-quality or lower-volume hospitals and if such differences explain disparities in receipt of definitive primary breast cancer therapy.

Research design: Observational study of a population-based sample of breast cancer patients included in the SEER-Medicare database.

Subjects: Fifty five thousand four hundred seventy white or black women aged >65 diagnosed with stage I/II breast cancer during 1992-2002.

Measures: Surgery at a high-quality hospital (top quartile rates of radiation after breast-conserving surgery) or high volume (top quartile) hospital and receipt of definitive primary therapy (mastectomy or breast-conserving surgery with radiation).

Results: Black women were significantly less likely than white women to be treated at high-quality hospitals (adjusted odds ratio [OR] 0.60; 95% confidence interval [CI]: 0.40-0.87) but not high-volume hospitals (adjusted OR 0.85; 95% CI: 0.54-1.34). Black women were less likely than white women to receive definitive primary therapy, a finding partially explained by having surgery at a high-quality hospital but not by having surgery at a high-volume hospital.

Conclusions: Older black women were more likely than white women to undergo breast cancer surgery at hospitals with lower rates of radiation following breast-conserving surgery, and this explains some of the reported racial disparities previously observed in receipt of definitive therapy for early-stage breast cancer. Interventions to help hospitals treating large numbers of black women improve rates of radiation after breast-conserving surgery may help to decrease racial disparities in care.

Publication types

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

MeSH terms

  • African Americans / ethnology
  • African Americans / statistics & numerical data*
  • Age Factors
  • Aged
  • Breast Neoplasms / diagnosis
  • Breast Neoplasms / ethnology
  • Breast Neoplasms / radiotherapy
  • Breast Neoplasms / surgery*
  • Chi-Square Distribution
  • European Continental Ancestry Group / ethnology
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Health Services Research
  • Healthcare Disparities / statistics & numerical data*
  • Hospitals / statistics & numerical data*
  • Humans
  • Logistic Models
  • Mastectomy / statistics & numerical data
  • Medicare / statistics & numerical data
  • Multivariate Analysis
  • Practice Patterns, Physicians' / statistics & numerical data
  • Quality of Health Care / statistics & numerical data*
  • SEER Program
  • Sensitivity and Specificity
  • Socioeconomic Factors
  • United States / epidemiology