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Member Research & Reports

Member Research & Reports

UAB Researcher Studies Disparities in Breast Cancer Outcomes by Insurance Status

Dr. Tomi Akinyemiju, assistant professor in the department of epidemiology at the University of Alabama at Birmingham — in collaboration with Ms. Swati Sakhuja, student research assistant in UAB’s department of epidemiology, and Dr. Neomi Vin-Raviv, of Colorado State University — ascertained in a recent study that racial differences were evident in outcomes among hospitalized patients with a primary diagnosis of breast cancer and that poorer outcomes were observed among Black women who had private insurance.

[Photo: Dr. Tomi Akinyemiju]

The investigators studied data regarding more than 67,000 participants in the 2007–2011 Healthcare Cost and Utilization Project National (Nationwide) Inpatient Sample (HCUP-NIS) to determine if insurance status (Medicare/Medicaid or private insurance) influenced results, after first adjusting for such factors as age, race/ethnicity, and socio-economic status. They analyzed the type of breast cancer surgery performed (mastectomy or breast conserving surgery [BCS]), complications experienced after surgery, and any incidences of in-hospital deaths, while noting that “differences in coverage, availability of networked physicians, or cost-sharing policies may influence choice of treatment and treatment outcomes, even after patients have been hospitalized, effects of which may be differential by race.”

The researchers further discerned that “Black patients were less likely to receive mastectomies compared with White women (odds ratio [OR]: 0.80, 95% confidence interval [CI]: 0.71–0.90), regardless of whether they had Medicare/Medicaid or private insurance. Black patients were also more likely to experience post-surgical complications (OR: 1.41, 95% CI: 1.12–1.78) and higher in-hospital mortality (OR: 1.57, 95%: 1.21–2.03) compared with White patients, associations that were strongest among women with private insurance. Women residing outside of large metropolitan areas were significantly more likely to receive mastectomies (OR: 1.89, 95% CI: 1.54–2.31) and experience higher in-hospital mortality (OR: 1.74, 95% CI: 1.40–2.16) compared with those in metropolitan areas, regardless of insurance type.”

Since the gap in the survival rate between Black and White women continues to widen despite several studies reporting racial disparities, Dr. Akinyemiju recommends further research to not only identify factors that are linked to worse outcomes among Black women but also to pinpoint reasons for the decreased use of BCS in non-metropolitan areas.

“Racial and Socio-economic Disparities in Breast Cancer Hospitalization Outcomes by Insurance Status” is published in August in the journal Cancer Epidemiology.

Journal article: