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Associations between health insurance status, neighborhood deprivation, and treatment delays in women with breast cancer living in Georgia

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Názov: Associations between health insurance status, neighborhood deprivation, and treatment delays in women with breast cancer living in Georgia
Autori: Awan, Sofia, Saini, Geetanjali, Gogineni, Keerthi, Luningham, Justin M., Collin, Lindsay J., Bhattarai, Shristi, Aneja, Ritu, Williams, Courtney P.
Zdroj: Cancer Medicine
Informácie o vydavateľovi: John Wiley & Sons, Inc.
Rok vydania: 2025
Zbierka: UNTHSC Scholarly Repository (University. of North Texas Health Science Center)
Predmety: breast cancer, disparities, socioeconomic, treatment initiation, Insurance, Health, Breast Neoplasms / epidemiology, Breast Neoplasms / therapy, Breast Neoplasms / diagnosis
Popis: BACKGROUND: Little is known regarding the association between insurance status and treatment delays in women with breast cancer and whether this association varies by neighborhood socioeconomic deprivation status. METHODS: In this cohort study, we used medical record data of women diagnosed with breast cancer between 2004 and 2022 at two Georgia-based healthcare systems. Treatment delay was defined as >90 days to surgery or >120 days to systemic treatment. Insurance coverage was categorized as private, Medicaid, Medicare, other public, or uninsured. Area deprivation index (ADI) was used as a proxy for neighborhood-level socioeconomic status. Associations between delayed treatment and insurance status were analyzed using logistic regression, with an interaction term assessing effect modification by ADI. RESULTS: Of the 14,195 women with breast cancer, 54% were non-Hispanic Black and 52% were privately insured. Compared with privately insured patients, those who were uninsured, Medicaid enrollees, and Medicare enrollees had 79%, 75%, and 27% higher odds of delayed treatment, respectively (odds ratio [OR]: 1.79, 95% confidence interval [CI]: 1.32-2.43; OR: 1.75, 95% CI: 1.43-2.13; OR: 1.27, 95% CI: 1.06-1.51). Among patients living in low-deprivation areas, those who were uninsured, Medicaid enrollees, and Medicare enrollees had 100%, 84%, and 26% higher odds of delayed treatment than privately insured patients (OR: 2.00, 95% CI: 1.44-2.78; OR: 1.84, 95% CI: 1.48-2.30; OR: 1.26, 95% CI: 1.05-1.53). No differences in the odds of delayed treatment by insurance status were observed in patients living in high-deprivation areas. DISCUSSION/CONCLUSION: Insurance status was associated with treatment delays for women living in low-deprivation neighborhoods. However, for women living in neighborhoods with high deprivation, treatment delays were observed regardless of insurance status. ; This study was supported by grant R01CA239120 from the National Cancer Institute (Dr Aneja). Lindsay J. Collin was supported by ...
Druh dokumentu: article in journal/newspaper
Popis súboru: application/pdf
Jazyk: unknown
Relation: https://doi.org/10.1002/cam4.6341; https://hdl.handle.net/20.500.12503/32982; 12; 16
Dostupnosť: https://hdl.handle.net/20.500.12503/32982
Rights: Attribution 4.0 International ; http://creativecommons.org/licenses/by/4.0/ ; © 2023 The Authors.
Prístupové číslo: edsbas.E2DA73
Databáza: BASE
Popis
Abstrakt:BACKGROUND: Little is known regarding the association between insurance status and treatment delays in women with breast cancer and whether this association varies by neighborhood socioeconomic deprivation status. METHODS: In this cohort study, we used medical record data of women diagnosed with breast cancer between 2004 and 2022 at two Georgia-based healthcare systems. Treatment delay was defined as >90 days to surgery or >120 days to systemic treatment. Insurance coverage was categorized as private, Medicaid, Medicare, other public, or uninsured. Area deprivation index (ADI) was used as a proxy for neighborhood-level socioeconomic status. Associations between delayed treatment and insurance status were analyzed using logistic regression, with an interaction term assessing effect modification by ADI. RESULTS: Of the 14,195 women with breast cancer, 54% were non-Hispanic Black and 52% were privately insured. Compared with privately insured patients, those who were uninsured, Medicaid enrollees, and Medicare enrollees had 79%, 75%, and 27% higher odds of delayed treatment, respectively (odds ratio [OR]: 1.79, 95% confidence interval [CI]: 1.32-2.43; OR: 1.75, 95% CI: 1.43-2.13; OR: 1.27, 95% CI: 1.06-1.51). Among patients living in low-deprivation areas, those who were uninsured, Medicaid enrollees, and Medicare enrollees had 100%, 84%, and 26% higher odds of delayed treatment than privately insured patients (OR: 2.00, 95% CI: 1.44-2.78; OR: 1.84, 95% CI: 1.48-2.30; OR: 1.26, 95% CI: 1.05-1.53). No differences in the odds of delayed treatment by insurance status were observed in patients living in high-deprivation areas. DISCUSSION/CONCLUSION: Insurance status was associated with treatment delays for women living in low-deprivation neighborhoods. However, for women living in neighborhoods with high deprivation, treatment delays were observed regardless of insurance status. ; This study was supported by grant R01CA239120 from the National Cancer Institute (Dr Aneja). Lindsay J. Collin was supported by ...