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

  1. Richard G. Roetzheim M.D., M.S.P.H.1,*,
  2. Eduardo C. Gonzalez M.D.1,
  3. Jeanne M. Ferrante M.D.1,
  4. Naazneen Pal M.P.H.1,
  5. Daniel J. Van Durme M.D.1,
  6. Jeffrey P. Krischer Ph.D.2

Article first published online: 6 DEC 2000

DOI: 10.1002/1097-0142(20001201)89:11<2202::AID-CNCR8>3.0.CO;2-L

Issue

Cancer

Cancer

Volume 89, Issue 11, pages 2202–2213, 1 December 2000

Additional Information

How to Cite

Roetzheim, R. G., Gonzalez, E. C., Ferrante, J. M., Pal, N., Van Durme, D. J. and Krischer, J. P. (2000), Effects of health insurance and race on breast carcinoma treatments and outcomes. Cancer, 89: 2202–2213. doi: 10.1002/1097-0142(20001201)89:11<2202::AID-CNCR8>3.0.CO;2-L

Author Information

  1. 1

    University of South Florida Department of Family Medicine, Tampa, Florida

  2. 2

    Division of Cancer Control, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida

*University of South Florida, Department of Family Medicine, 12901 Bruce B. Downs Boulevard, MDC 13, Tampa, FL 33612;

Publication History

  1. Issue published online: 6 DEC 2000
  2. Article first published online: 6 DEC 2000
  3. Manuscript Revised: 21 JUL 2000
  4. Manuscript Accepted: 21 JUL 2000
  5. Manuscript Received: 20 MAR 2000

Funded by

  • Robert Wood Johnson Foundation

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Keywords:

  • breast neoplasms;
  • health insurance;
  • Medicaid;
  • Medicare;
  • managed care programs;
  • health maintenance organizations;
  • medically uninsured;
  • ethnic groups;
  • registries;
  • Florida

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. Cancer 2000;89:2202–13. © 2000 American Cancer Society.

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