An investigation of the association between racial disparities in breast cancer treatment outcomes and facility characteristics Open Access
Osborn, Catherine (Spring 2019)
Abstract
Previous epidemiologic studies have found that racial disparities in breast cancer-specific mortality are partially attributed to increased surgical delays for black women compared to white women, even after controlling for insurance coverage and access to care. Previous studies have also found that racial disparities in breast cancer outcomes may be partially attributed to the facility in which women receive treatment.No previous studies have investigated whether the racial disparities in treatment delays and mortality are associated with facility-level characteristics. The current study investigates which facility characteristics are associated with increased racial disparities in surgical delays for breast cancer treatment and in breast cancer-specific mortality. Logistic regression was used to model facility characteristics and treatment delay. Cox proportional hazard regression was used to model facility characteristics and mortality. Interactions by patient race was assessed for both associations. The final sample included 3,857 white and 2,341 black women from 35 Metro Atlanta surgical facilities. The median surgical delay was higher in black women (36.0; SD=50.69) compared to white women (29.0; SD=26.50). The largest disparities in delay between white and black women were among patients with Medicare, patients treated in low or moderate volume facilities, government facilities, or facilities with an ACOSOG affiliation. Facilities without a medical school affiliation had lower odds of surgical delay for white patients (aOR=0.89, 95% CI: 0.71, 1.11), but higher odds among black patients (aOR=1.11, 95% CI: 0.92, 1.34). Government (aOR=0.72, 95% CI: 0.66, 0.79) and for-profit hospitals (aOR=0.72, 95% CI: 0.81, 0.89) had lower odds of surgical delay compared to non-profit hospitals. High facility volume was inversely associated with mortality among white patients (aHR=0.60, 95% CI: 0.44, 0.83), yet positively associated among black patients (aHR=1.32, 95% CI: 0.85, 2.05). COC-accreditation was inversely associated with mortality among white patients (aHR=0.69, 95% CI: 0.38, 1.17), yet positively associated among black patients (aHR=1.18, 95% CI: 0.74, 1.88). Future studies with larger samples of patients, which can obtain surgical delay and breast cancer-specific mortality should continue to investigate the associations between various facility characteristics and patient outcomes.
Table of Contents
CHAPTER I: BACKGROUND/LITERATURE REVIEW .............................................. 1
1.1.1 Epidemiology and risk factors .................................................................................. 1
1.1.2 Breast cancer subtypes .............................................................................................. 1
1.1.3 Treatment of breast cancer......................................................................................... 2
1.2 Racial Disparities in Breast Cancer ............................................................................. 3
1.3 Treatment Disparities ................................................................................................... 4
1.4 Role of Health Care Facility .........................................................................................6
1.5 Significance of Thesis .................................................................................................. 8
CHAPTER II: AN INVESTIGATION OF THE ASSOCIATION BETWEEN RACIAL DISPARITIES IN BREAST CANCER TREATMENT OUTCOMES AND FACILITY CHARACTERISTICS ... 10
2.1 Abstract ...................................................................................................................... 10
2.2 Introduction................................................................................................................. 10
2.3 Methods....................................................................................................................... 12
2.3.1 Study design and population….......................................................................……..12
2.3.2 Exposure assessment….............................................................................................12
2.3.3 Outcome assessment.................................................................................................13
2.3.4 Statistical analysis.....................................................................................................13
2.4 Results......................................................................................................................... 14
2.5 Discussion .................................................................................................................. 16
2.5.1 Strengths and limitations…...................................................................................…16
2.5.2 Conclusions..........................................................................................................….17
CHAPTER III: SUMMARY, PUBLIC HEALTH IMPLICATIONS, POSSIBLE FUTURE DIRECTIONS ... 18
3.1 Appendices ................................................................................................................ 19
3.2 References……......................................................................................................…..25
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