Racial/Ethnic Differences in Receipt of Timely Adjuvant Therapy for Older Women with Breast Cancer: Are Delays Influenced by the Hospitals Where Patients Obtain Surgical Care?
Article first published online: 13 MAY 2013
© Health Research and Educational Trust
Health Services Research
Volume 48, Issue 5, pages 1669–1683, October 2013
How to Cite
Freedman, R. A., He, Y., Winer, E. P. and Keating, N. L. (2013), Racial/Ethnic Differences in Receipt of Timely Adjuvant Therapy for Older Women with Breast Cancer: Are Delays Influenced by the Hospitals Where Patients Obtain Surgical Care?. Health Services Research, 48: 1669–1683. doi: 10.1111/1475-6773.12063
- Issue published online: 16 SEP 2013
- Article first published online: 13 MAY 2013
- California Health and Safety Code Section. Grant Number: 103885
- National Cancer Institute's Surveillance, Epidemiology and End Results Program. Grant Number: N01-PC-35136
- Northern California Cancer Center. Grant Number: N01-PC-35139
- University of Southern California. Grant Number: N02-PC45105
- Public Health Institute
- Centers for Disease tool and Prevention's National Program of Cancer Registries. Grant Number: U55/CCR921930-02
- Breast cancer;
To examine whether hospitals where patients obtain care explain racial/ethnic differences in treatment delay.
Surveillance, Epidemiology, and End Results data linked with Medicare claims.
We examined delays in adjuvant chemotherapy or radiation for women diagnosed with stage I–III breast cancer during 1992–2007. We used multivariable logistic regression to assess the probability of delay by race/ethnicity and included hospital fixed effects to assess whether hospitals explained disparities.
Among 54,592 women, black (11.9 percent) and Hispanic (9.9 percent) women had more delays than whites (7.8 percent, p < .0001). After adjustment, black (vs. white) women had higher odds of delay (odds ratio = 1.25, 95 percent confidence interval = 1.10–1.42), attenuated somewhat by including hospital fixed effects (OR = 1.17, 95 percent CI = 1.02–1.33).
Hospitals are the important contributors to racial disparities in treatment delay.