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. 2013 Oct;48(5):1669-83.
doi: 10.1111/1475-6773.12063. Epub 2013 May 13.

Racial/Ethnic differences in receipt of timely adjuvant therapy for older women with breast cancer: are delays influenced by the hospitals where patients obtain surgical care?

Rachel A Freedman  1 , Yulei He, Eric P Winer, Nancy L Keating
Affiliations

Racial/Ethnic differences in receipt of timely adjuvant therapy for older women with breast cancer: are delays influenced by the hospitals where patients obtain surgical care?

Rachel A Freedman et al. Health Serv Res. 2013 Oct.

Abstract

Objective: To examine whether hospitals where patients obtain care explain racial/ethnic differences in treatment delay.

Data source: Surveillance, Epidemiology, and End Results data linked with Medicare claims.

Study design: We examined delays in adjuvant chemotherapy or radiation for women diagnosed with stage I-III breast cancer during 1992-2007. We used multivariable logistic regression to assess the probability of delay by race/ethnicity and included hospital fixed effects to assess whether hospitals explained disparities.

Principal findings: Among 54,592 women, black (11.9 percent) and Hispanic (9.9 percent) women had more delays than whites (7.8 percent, p < .0001). After adjustment, black (vs. white) women had higher odds of delay (odds ratio = 1.25, 95 percent confidence interval = 1.10-1.42), attenuated somewhat by including hospital fixed effects (OR = 1.17, 95 percent CI = 1.02-1.33).

Conclusions: Hospitals are the important contributors to racial disparities in treatment delay.

Keywords: Breast cancer; delays; disparities.

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