Can Regionalization of Care Reduce Socioeconomic Disparities in Breast Cancer Survival?
Med Care
; 59(1): 77-81, 2021 01.
Article
em En
| MEDLINE
| ID: mdl-33201083
ABSTRACT
BACKGROUND:
Breast cancer patients of low socioeconomic status (SES) have worse survival than more affluent women and are also more likely to undergo surgery in low-volume facilities. Since breast cancer patients treated in high-volume facilities have better survival, regionalizing the care of low SES patients toward high-volume facilities might reduce SES disparities in survival.OBJECTIVE:
We leverage a natural experiment in New York state to examine whether a policy precluding payment for breast cancer surgery for New York Medicaid beneficiaries undergoing surgery in low-volume facilities led to reduced SES disparities in mortality. RESEARCHDESIGN:
A multivariable difference-in-differences regression analysis compared mortality of low SES (dual enrollees, Medicare-Medicaid) breast cancer patients to that of wealthier patients exempt from the policy (Medicare only) for time periods before and after the policy implementation.SUBJECTS:
A total of 14,183 Medicare beneficiaries with breast cancer in 2006-2008 or 2014-2015.MEASURES:
All-cause mortality at 3 years after diagnosis and Medicaid status, determined by Medicare administrative data.RESULTS:
Both low SES and Medicare-only patients had better 3-year survival after the policy implementation. However, the decline in mortality was larger in magnitude among the low SES women than others, resulting in a 53% smaller SES survival disparity after the policy after adjustment for age, race, and comorbid illness.CONCLUSION:
Regionalization of early breast cancer care away from low-volume centers may improve outcomes and reduce SES disparities in survival.
Texto completo:
1
Temas:
ECOS
/
Aspectos_gerais
Bases de dados:
MEDLINE
Assunto principal:
Fatores Socioeconômicos
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Neoplasias da Mama
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Medicare
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Medicaid
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Disparidades em Assistência à Saúde
Tipo de estudo:
Diagnostic_studies
Aspecto:
Determinantes_sociais_saude
Limite:
Aged
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Female
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Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Med Care
Ano de publicação:
2021
Tipo de documento:
Article