Associations between health insurance status, neighborhood deprivation, and treatment delays in women with breast cancer living in Georgia
Abstract Background Little is known regarding the association between insurance status and treatment delays in women with breast cancer and whether this association varies by neighborhood socioeconomic deprivation status. Methods In this cohort study, we used medical record data of women diagnosed w...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-08-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.6341 |
| _version_ | 1827307638933684224 |
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| author | Sofia Awan Geetanjali Saini Keerthi Gogineni Justin M. Luningham Lindsay J. Collin Shristi Bhattarai Ritu Aneja Courtney P. Williams |
| author_facet | Sofia Awan Geetanjali Saini Keerthi Gogineni Justin M. Luningham Lindsay J. Collin Shristi Bhattarai Ritu Aneja Courtney P. Williams |
| author_sort | Sofia Awan |
| collection | DOAJ |
| description | Abstract Background Little is known regarding the association between insurance status and treatment delays in women with breast cancer and whether this association varies by neighborhood socioeconomic deprivation status. Methods In this cohort study, we used medical record data of women diagnosed with breast cancer between 2004 and 2022 at two Georgia‐based healthcare systems. Treatment delay was defined as >90 days to surgery or >120 days to systemic treatment. Insurance coverage was categorized as private, Medicaid, Medicare, other public, or uninsured. Area deprivation index (ADI) was used as a proxy for neighborhood‐level socioeconomic status. Associations between delayed treatment and insurance status were analyzed using logistic regression, with an interaction term assessing effect modification by ADI. Results Of the 14,195 women with breast cancer, 54% were non‐Hispanic Black and 52% were privately insured. Compared with privately insured patients, those who were uninsured, Medicaid enrollees, and Medicare enrollees had 79%, 75%, and 27% higher odds of delayed treatment, respectively (odds ratio [OR]: 1.79, 95% confidence interval [CI]: 1.32–2.43; OR: 1.75, 95% CI: 1.43–2.13; OR: 1.27, 95% CI: 1.06–1.51). Among patients living in low–deprivation areas, those who were uninsured, Medicaid enrollees, and Medicare enrollees had 100%, 84%, and 26% higher odds of delayed treatment than privately insured patients (OR: 2.00, 95% CI: 1.44–2.78; OR: 1.84, 95% CI: 1.48–2.30; OR: 1.26, 95% CI: 1.05–1.53). No differences in the odds of delayed treatment by insurance status were observed in patients living in high‐deprivation areas. Discussion/Conclusion Insurance status was associated with treatment delays for women living in low‐deprivation neighborhoods. However, for women living in neighborhoods with high deprivation, treatment delays were observed regardless of insurance status. |
| first_indexed | 2024-03-12T00:55:01Z |
| format | Article |
| id | doaj.art-321aeb94adfe45059ad183d04694b03d |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-04-24T18:43:01Z |
| publishDate | 2023-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-321aeb94adfe45059ad183d04694b03d2024-03-27T09:11:00ZengWileyCancer Medicine2045-76342023-08-011216173311733910.1002/cam4.6341Associations between health insurance status, neighborhood deprivation, and treatment delays in women with breast cancer living in GeorgiaSofia Awan0Geetanjali Saini1Keerthi Gogineni2Justin M. Luningham3Lindsay J. Collin4Shristi Bhattarai5Ritu Aneja6Courtney P. Williams7School of Public Health, Georgia State University Atlanta Georgia USADepartment of Clinical and Diagnostic Sciences, School of Health Professions University of Alabama at Birmingham Birmingham Alabama USADepartment of Hematology–Medical Oncology Winship Cancer Institute, Emory University School of Medicine Atlanta Georgia USADepartment of Biostatistics and Epidemiology, School of Public Health University of North Texas Health Science Center Fort Worth Texas USADepartment of Population Health Sciences Huntsman Cancer Institute, University of Utah Salt Lake City Utah USADepartment of Clinical and Diagnostic Sciences, School of Health Professions University of Alabama at Birmingham Birmingham Alabama USADepartment of Clinical and Diagnostic Sciences, School of Health Professions University of Alabama at Birmingham Birmingham Alabama USADepartment of Medicine, Division of Preventive Medicine University of Alabama at Birmingham Birmingham Alabama USAAbstract Background Little is known regarding the association between insurance status and treatment delays in women with breast cancer and whether this association varies by neighborhood socioeconomic deprivation status. Methods In this cohort study, we used medical record data of women diagnosed with breast cancer between 2004 and 2022 at two Georgia‐based healthcare systems. Treatment delay was defined as >90 days to surgery or >120 days to systemic treatment. Insurance coverage was categorized as private, Medicaid, Medicare, other public, or uninsured. Area deprivation index (ADI) was used as a proxy for neighborhood‐level socioeconomic status. Associations between delayed treatment and insurance status were analyzed using logistic regression, with an interaction term assessing effect modification by ADI. Results Of the 14,195 women with breast cancer, 54% were non‐Hispanic Black and 52% were privately insured. Compared with privately insured patients, those who were uninsured, Medicaid enrollees, and Medicare enrollees had 79%, 75%, and 27% higher odds of delayed treatment, respectively (odds ratio [OR]: 1.79, 95% confidence interval [CI]: 1.32–2.43; OR: 1.75, 95% CI: 1.43–2.13; OR: 1.27, 95% CI: 1.06–1.51). Among patients living in low–deprivation areas, those who were uninsured, Medicaid enrollees, and Medicare enrollees had 100%, 84%, and 26% higher odds of delayed treatment than privately insured patients (OR: 2.00, 95% CI: 1.44–2.78; OR: 1.84, 95% CI: 1.48–2.30; OR: 1.26, 95% CI: 1.05–1.53). No differences in the odds of delayed treatment by insurance status were observed in patients living in high‐deprivation areas. Discussion/Conclusion Insurance status was associated with treatment delays for women living in low‐deprivation neighborhoods. However, for women living in neighborhoods with high deprivation, treatment delays were observed regardless of insurance status.https://doi.org/10.1002/cam4.6341breast cancerdisparitiesinsurance coveragesocioeconomictreatment initiation |
| spellingShingle | Sofia Awan Geetanjali Saini Keerthi Gogineni Justin M. Luningham Lindsay J. Collin Shristi Bhattarai Ritu Aneja Courtney P. Williams Associations between health insurance status, neighborhood deprivation, and treatment delays in women with breast cancer living in Georgia Cancer Medicine breast cancer disparities insurance coverage socioeconomic treatment initiation |
| title | Associations between health insurance status, neighborhood deprivation, and treatment delays in women with breast cancer living in Georgia |
| title_full | Associations between health insurance status, neighborhood deprivation, and treatment delays in women with breast cancer living in Georgia |
| title_fullStr | Associations between health insurance status, neighborhood deprivation, and treatment delays in women with breast cancer living in Georgia |
| title_full_unstemmed | Associations between health insurance status, neighborhood deprivation, and treatment delays in women with breast cancer living in Georgia |
| title_short | Associations between health insurance status, neighborhood deprivation, and treatment delays in women with breast cancer living in Georgia |
| title_sort | associations between health insurance status neighborhood deprivation and treatment delays in women with breast cancer living in georgia |
| topic | breast cancer disparities insurance coverage socioeconomic treatment initiation |
| url | https://doi.org/10.1002/cam4.6341 |
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