Having health insurance does not eliminate race/ethnicity-associated delays in breast cancer diagnosis in the District of Columbia

Authors

  • Heather J. Hoffman PhD,

    Corresponding author
    1. Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, Washington, District of Columbia
    2. The George Washington Cancer Institute,Washington, District of Columbia
    • Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, 2100-W Pennsylvania Avenue, NW, 8th Floor, Washington, DC 20037
    Search for more papers by this author
    • Fax: (202) 994-0082

  • Nancy L. LaVerda MPH,

    1. The George Washington Cancer Institute,Washington, District of Columbia
    Search for more papers by this author
  • Paul H. Levine MD,

    1. Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, Washington, District of Columbia
    2. The George Washington Cancer Institute,Washington, District of Columbia
    Search for more papers by this author
  • Heather A. Young PhD,

    1. Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, Washington, District of Columbia
    2. The George Washington Cancer Institute,Washington, District of Columbia
    Search for more papers by this author
  • Lisa M. Alexander EdD,

    1. The George Washington Cancer Institute,Washington, District of Columbia
    Search for more papers by this author
  • Steven R. Patierno PhD

    1. The George Washington Cancer Institute,Washington, District of Columbia
    Search for more papers by this author

  • The District of Columbia Citywide Patient Navigator Research Program (DC-PNRP) Research Group: Dr. Rachel Brem, Director of Breast Imaging and Intervention, The George Washington University Medical Center, Washington, DC, Dr. Wayne Frederick, Director of the Howard University Cancer Center and Division Chief, General Surgery, Howard University, Washington, DC, Dr. William Funderburk, Surgeon, Providence Hospital and Washington Hospital Center, Dr. Sandra Swain, Medical Director of Washington Hospital Cancer Institute at Washington Hospital Center, Washington, DC.

Abstract

BACKGROUND:

Delays in follow-up after breast cancer screening contribute to disparities in breast cancer outcomes. The objective of this research was to determine the impact of race/ethnicity and health insurance on diagnostic time, defined as number of days from suspicious finding to diagnostic resolution.

METHODS:

This retrospective cohort study of 1538 women examined for breast abnormalities between 1998-2010 at 6 hospitals/clinics in the District of Columbia measured mean diagnostic times between non-Hispanic whites (NHWs), non-Hispanic blacks (NHBs), and Hispanics with private, government, or no health insurance by using a full-factorial ANOVA model.

RESULTS:

Respective average—geometric mean (95% CI)—diagnostic times (in days) for NHWs, NHBs, and Hispanics were 16 (12, 21), 27 (23, 33), and 51 (35, 76) among privately insured; 12 (7, 19), 39 (32, 48), and 71 (48, 105) among government insured; 45 (17, 120), 60 (39, 92), and 67 (56, 79) among uninsured. Government insured NHWs had significantly shorter diagnostic times than government insured NHBs (P = .0003) and Hispanics (P < .0001). Privately insured NHWs had significantly shorter diagnostic times than privately insured NHBs (P = .03) and Hispanics (P < .0001). Privately insured NHBs had significantly shorter diagnostic times than uninsured NHBs (P = .03).

CONCLUSIONS:

Insured minorities waited >2 times longer to reach their diagnostic resolution than insured NHWs. Having private health insurance increased the speed of diagnostic resolution in NHBs; however, their diagnostic time remained significantly longer than for privately insured NHWs. These results suggest diagnostic delays in minorities are more likely caused by other barriers associated with race/ethnicity than by insurance status. Cancer 2011;. © 2011 American Cancer Society.

Ancillary