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Race versus place of service in mortality among Medicare beneficiaries with cancer†
Article first published online: 22 MAR 2010
Copyright © 2010 American Cancer Society
Volume 116, Issue 11, pages 2698–2706, 1 June 2010
How to Cite
Onega, T., Duell, E. J., Shi, X., Demidenko, E. and Goodman, D. C. (2010), Race versus place of service in mortality among Medicare beneficiaries with cancer. Cancer, 116: 2698–2706. doi: 10.1002/cncr.25097
For this study, the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program (National Cancer Institute); the Office of Research, Development, and Information (Centers for Medicare and Medicaid Services); Information Management Services, Inc.; and the SEER Program tumor registries in the creation of the SEER-Medicare database.
- Issue published online: 19 MAY 2010
- Article first published online: 22 MAR 2010
- Manuscript Accepted: 7 OCT 2009
- Manuscript Revised: 2 OCT 2009
- Manuscript Received: 29 JUL 2009
- National Institutes of Health grant. Grant Number: 1 P20 RR018787
- Institutional Development Award (IDeA) Program of the National Center for Research Resources and by the Agency for Healthcare Research and Quality under Ruth L. Kirschstein National Research Service Award. Grant Number: T32HS000070
- healthcare disparities;
- quality of healthcare;
- health facilities
Evidence suggests that excess mortality among African-American cancer patients is explained in part by the healthcare setting. The objective of this study was to compare mortality among African-American and Caucasian cancer patients and to evaluate the influence of attendance at a National Cancer Institute (NCI)-designated comprehensive or clinical cancer center.
The authors conducted a retrospective cohort analysis of Medicare beneficiaries with an incident diagnosis of lung, breast, colorectal, or prostate cancer between 1998 and 2002 who were identified from Surveillance, Epidemiology, and End Results data. Multivariate logistic regression models were used to assess the impact of NCI cancer center attendance and race on all-cause and cancer-specific mortality at 1 year and 3 years after diagnosis.
The likelihood of 1-year and 3-year all-cause and cancer-specific mortality was higher for African Americans than for Caucasians in crude and adjusted models (cancer-specific adjusted: Caucasian referent, 1-year odds ratio [OR], 1.13; 95% confidence interval [CI], 1.07-1.19; 3-year OR, 1.23; 95% CI, 1.17-1.30). By cancer site, cancer-specific mortality was higher among African Americans at 1 year for breast and colorectal cancers and for all cancers at 3 years. NCI cancer center attendance was associated with significantly lower odds of mortality for African Americans (1-year OR, 0.63; 95% CI, 0.56-0.76; 3-year OR, 0.71; 95% CI, 0.62-0.81). With Caucasians as the referent group, the excess mortality risk among African Americans no longer was observed for all-cause or cancer-specific mortality risk among patients who attended NCI cancer centers (cancer-specific mortality:1-year OR, 0.95; 95% CI, 0.76-1.19; 3-year OR, 1.00; 95% CI, 0.82-1.21).
African-American Medicare beneficiaries with lung, breast, colorectal, and prostate cancers had higher mortality compared with their Caucasian counterparts; however, there were no significant differences in mortality by race among those who attended NCI cancer centers. The results of this study suggested that place of service may explain some of the cancer mortality excess observed in African Americans. Cancer 2010. © 2010 American Cancer Society.