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. 2017 May;55(5):463-469.
doi: 10.1097/MLR.0000000000000685.

Socioeconomic Disparities in Mortality Among Women With Incident Breast Cancer Before and After Implementation of Medicare Part D

Ann B Nattinger  1 , Erica M Wozniak, Emily L McGinley, Jianing Li, Purushottam Laud, Liliana E Pezzin
Affiliations

Socioeconomic Disparities in Mortality Among Women With Incident Breast Cancer Before and After Implementation of Medicare Part D

Ann B Nattinger et al. Med Care. 2017 May.

Abstract

Background: Breast cancer patients exhibit survival disparities based on socioeconomic status (SES). Disparities may be attributable to access to expensive oral endocrine agents.

Objectives: Define recent socioeconomic disparities in breast cancer survival and determine whether these improved after implementation of the Medicare Part D program.

Design: Difference-in-difference natural experiment of women diagnosed and treated before or after implementation of Medicare Part D.

Subjects: Female Medicare beneficiaries with early-stage breast cancer: 54,772 diagnosed in 2001 and 46,371 in 2007.

Measures: SES was based on Medicaid enrollment and zip code per capita income, all-cause mortality from Medicare, and cause of death from National Death Index.

Results: Among women diagnosed pre-Part D, 40.5% of poor beneficiaries had died within 5 years compared with 20.3% of high-income women (P<0.0001). Post-Part D, 33.6% of poor women and 18.4% of high-income women died by 5 years. After adjustment for potential confounders, improvement in all-cause mortality post-Part D was greater for poorer women compared with more affluent women (P=0.002). However, absolute improvement in breast cancer-specific mortality was 1.8%, 1.2%, and 0.8% (P=0.88 for difference in improvement by SES), respectively for poor, near-poor, and high-income women, whereas analogous improvement in mortality from other causes was 5.1%, 3.8%, and 0.9% (P=0.067 for difference in improvement by SES).

Conclusions: Large survival disparities by SES exist among breast cancer patients. The Part D program successfully ameliorated SES disparities in all-cause mortality. However, improvement was concentrated in causes of death other than breast cancer, suggesting remaining gaps in care.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
All-cause mortality among women with incident early-stage breast cancer, by Part D exposure and socioeconomic status.
FIGURE 2
FIGURE 2
Breast cancer-specific mortality among women with incident early-stage breast cancer, by Part D exposure and socioeconomic status.
See this image and copyright information in PMC

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