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<h5 class="section-title" id="d11446822e142">Background</h5>
<p id="P1">Breast cancer remains a major cause of morbidity and mortality among women
in the
US, and despite numerous studies documenting racial disparities in outcomes, the survival
difference between Black and White women diagnosed with breast cancer continues to
widen. Few studies have assessed whether observed racial disparities in outcomes vary
by insurance type e.g. Medicare/Medicaid versus private insurance. 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.
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<h5 class="section-title" id="d11446822e147">Purpose</h5>
<p id="P2">The aim of this analysis was to examine hospitalization outcomes among
patients with
a primary diagnosis of breast cancer and assess whether differences in outcome exist
by insurance status after adjusting for age, race/ethnicity and socio-economic status.
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<h5 class="section-title" id="d11446822e152">Methods</h5>
<p id="P3">We obtained data on over 67,000 breast cancer patients with a primary diagnosis
of
breast cancer for this cross-sectional study from the 2007-2011 Healthcare Cost and
Utilization project Nationwide Inpatient Sample (HCUP-NIS), and examined breast cancer
surgery type (mastectomy vs. breast conserving surgery or BCS), post-surgical complications
and in-hospital mortality. Multivariable regression models were used to compute estimates,
odds ratios and 95% confidence intervals.
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<h5 class="section-title" id="d11446822e157">Results</h5>
<p id="P4">Black patients were less likely to receive mastectomies compared with White
women
(OR: 0.80, 95% 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.
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<h5 class="section-title" id="d11446822e162">Conclusion</h5>
<p id="P5">Among hospitalized patients with breast cancer, racial differences in hospitalization
outcomes existed and worse outcomes were observed among Black women with private insurance.
Future studies are needed to determine factors associated with poor outcomes in this
group of women, as well as to examine contributors to low BCS adoption in non-metropolitan
areas.
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