Preexisting Diabetes and Breast Cancer Treatment Among Low-Income Women.

IMPORTANCE: Diabetes is associated with poorer prognosis of patients with breast cancer. The association between diabetes and adjuvant therapies for breast cancer remains uncertain. OBJECTIVE: To comprehensively examine the associations of preexisting diabetes with radiotherapy, chemotherapy, and endocrine therapy in low-income women with breast cancer. DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study included women younger than 65 years diagnosed with nonmetastatic breast cancer from 2007 through 2015, followed up through 2016, continuously enrolled in Medicaid, and identified from the linked Missouri Cancer Registry and Medicaid claims data set. Data were analyzed from January 2022 to October 2023. EXPOSURE: Preexisting diabetes. MAIN OUTCOMES AND MEASURES: Logistic regression was used to estimate odds ratios (ORs) of utilization (yes/no), timely initiation (≤90 days postsurgery), and completion of radiotherapy and chemotherapy, as well as adherence (medication possession ratio ≥80%) and persistence (<90-consecutive day gap) of endocrine therapy in the first year of treatment for women with diabetes compared with women without diabetes. Analyses were adjusted for sociodemographic and tumor factors. RESULTS: Among 3704 women undergoing definitive surgery, the mean (SD) age was 51.4 (8.6) years, 1038 (28.1%) were non-Hispanic Black, 2598 (70.1%) were non-Hispanic White, 765 (20.7%) had a diabetes history, 2369 (64.0%) received radiotherapy, 2237 (60.4%) had chemotherapy, and 2505 (67.6%) took endocrine therapy. Compared with women without diabetes, women with diabetes were less likely to utilize radiotherapy (OR, 0.67; 95% CI, 0.53-0.86), receive chemotherapy (OR, 0.67; 95% CI, 0.48-0.93), complete chemotherapy (OR, 0.71; 95% CI, 0.50-0.99), and be adherent to endocrine therapy (OR, 0.71; 95% CI, 0.56-0.91). There were no significant associations of diabetes with utilization (OR, 0.95; 95% CI, 0.71-1.28) and persistence (OR, 1.09; 95% CI, 0.88-1.36) of endocrine therapy, timely initiation of radiotherapy (OR, 1.09; 95% CI, 0.86-1.38) and chemotherapy (OR, 1.09; 95% CI, 0.77-1.55), or completion of radiotherapy (OR, 1.25; 95% CI, 0.91-1.71). CONCLUSIONS AND RELEVANCE: In this cohort study, preexisting diabetes was associated with subpar adjuvant therapies for breast cancer among low-income women. Improving diabetes management during cancer treatment is particularly important for low-income women with breast cancer who may have been disproportionately affected by diabetes and are likely to experience disparities in cancer treatment and outcomes.

The Effect of the COVID-19 Pandemic on the Social Inequalities of Health Care Use in Hungary: A Nationally Representative Cross-Sectional Study.

BACKGROUND: The social representation of restricted health care use during the COVID-19 pandemic has not been evaluated properly yet in Hungary. OBJECTIVE: Our study aimed to quantify the effect of COVID-19 pandemic measures on general practitioner (GP) visits, specialist care, hospitalization, and cost-related prescription nonredemption (CRPNR) among adults, and to identify the social strata susceptible to the pandemic effect. METHODS: This cross-sectional study was based on nationally representative data of 6611 (Nprepandemic = 5603 and Npandemic = 1008) adults. Multivariable logistic regression models were applied to determine the sociodemographic and clinical factors influencing health care use by odds ratios (ORs) along with the corresponding 95% confidence intervals (CI). To identify the social strata susceptible to the pandemic effect, the interaction of the time of data collection with the level of education, marital status, and Roma ethnicity, was tested and described by iORs. RESULTS: While the CRPNR did not change, the frequency of GP visits, specialist care, and hospitalization rates was remarkably reduced by 22.2%, 26.4%, and 6.7%, respectively, during the pandemic. Roma proved to be not specifically affected by the pandemic in any studied aspect, and the pandemic restructuring of health care impacted the social subgroups evenly with respect to hospital care. However, the pandemic effect was weaker among primary educated adults (iORGP visits, high-school vs. primary-education = 0.434; 95% CI 0.243-0.776, ORspecialist visit, high-school vs. primary-education = 0.598; 95% CI 0.364-0.985), and stronger among married adults (iORGP visit, widowed vs. married = 2.284; 95% CI 1.043-4.998, iORspecialist visit, widowed vs. married = 1.915; 95% CI 1.157-3.168), on the frequency of GP visits and specialist visits. The prepandemic CRPNR inequality by the level of education was increased (iORhigh-school vs. primary-education = 0.236; 95% CI 0.075-0.743). CONCLUSION: Primary educated and widowed adults did not follow the general trend, and their prepandemic health care use was not reduced during the pandemic. This shows that although the management of pandemic health care use restrictions was implemented by not increasing social inequity, the drug availability for primary educated individuals could require more support.

Exclusive breastfeeding cessation and associated factors among employed mothers in Dukem town, Central Ethiopia.

BACKGROUND: Employed women tend to exclusively breastfeed less than non-employed women. Early returning to work has been major reason why employed women stop exclusive breastfeeding. The aim of this study was to investigate exclusive breastfeeding (EBF) cessation and associated factors among employed mothers in Dukem town, Central Ethiopia. METHODS: A cross-sectional study was conducted from February to March 2015 using total sample of 313 randomly selected permanently employed women. Information regarding participants' work-related factors, health service and sociodemographic factors were collected by face to face interview using structured questionnaire. Data were checked for completeness, entered and analyzed by SPSS version 20. Binary logistic regression was done to identify factors associated with exclusive breastfeeding cessation. The strength of association was measured using odds ratio with 95% confidence intervals. RESULTS: Prevalence of exclusive breastfeeding cessation was 75.7% (95% CI 71.0, 80.5%). Having a short duration of maternity leave (AOR 9.3; 95% CI 3.8, 23), being a full time employee (AOR 3.5; 95% CI 1.7, 11), being private organization employee (AOR=2.1, 95% CI(1, 4.3)), lack of flexible work time (AOR 3.0; 95% CI 1.2, 7.5), not pumping breast milk (AOR 4.3; 95% CI 1.7, 11), lack of a lactation break (AOR 6.7; 95% CI 3,14.5) and work place far away from her child (AOR 3.1; 95% CI 3.1, 6.3), were significantly associated with cessation of EBF among employed mothers. CONCLUSION: Prevalence of exclusive breastfeeding cessation was much higher than the international and national expectation. The concerned governmental bodies should consider improving the legislation of the 3 months postpartum maternity leave to reduce employed mother's exclusive breastfeeding cessation.