Evidence for racial/ethnic disparities in emergency department visits following breast cancer surgery among women in California: a population-based study

Abstract

Purpose: Racial/ethnic disparities in breast cancer outcomes may be related to quality of care and reflected in emergency department (ED) visits following primary treatment. We examined racial/ethnic variation in ED visits following breast cancer surgery.

Methods: Using linked data from the California Cancer Registry and California Office of Statewide Health Planning and Development, we identified 151,229 women diagnosed with stage 0-III breast cancer between 2005 and 2013 who received surgical treatment. Differences in odds of having at least one breast cancer-related ED visit within 90 days post-surgery were estimated with logistic regression controlling for clinical and sociodemographic variables. Secondary analyses examined health care-related moderators of disparities.

Results: Hispanics and non-Hispanic (NH) Blacks had an increased likelihood of having an ED visit within 90 days of surgery compared to NH Whites [OR = 1.11 (1.04-1.18), p = 0.0016; OR = 1.38 (1.27-1.50), p < 0.0001, respectively]; the likelihood was reduced in Asian/Pacific Islanders [aOR = 0.77 (0.71-0.84), p < 0.0001]. Medicaid and Medicare (vs. commercial insurance) increased the likelihood of ED visit for NH Whites, and to a lesser degree for Hispanics and NH Blacks (p < 0.0001 for interaction). Receipt of surgery at an NCI-designated Comprehensive Cancer Center or at a for-profit (vs. non-profit) hospital was associated with reduced likelihood of ED visits for all groups.

Conclusion: Racial/ethnic disparities in ED visits following breast cancer surgery persist after controlling for clinical and sociodemographic variables. Improving quality of care following breast cancer surgery could improve outcomes for all groups.

Keywords: Breast cancer; Emergency department visits; Health disparities.

Fig. 1

Study flow diagram

Fig. 2

ED visits by race/ethnicity and insurance coverage. Percent of patients with at least one ED visit in the 90 days after surgery by race/ethnicity and insurance coverage. In the multivariable logistic regression, there was a significant race/ethnicity by insurance coverage interaction effect (p < 0.0001). Values shown are adjusted odds ratios (95% confidence intervals) from post hoc logistic regression models of relationship between insurance coverage and ED visits stratified by race/ethnicity. A all, C commercial, MA Medicaid, MC Medicare; *p < 0.01; **p < 0.001; ***p < 0.0001