TY - JOUR
T1 - Disparities in Late-Stage Breast and Colorectal Cancer Diagnosis Among Hispanic, Non-Hispanic White, and Non-Hispanic Black Patients
T2 - a Retrospective Cohort Study of Texas Medicare Beneficiaries
AU - Nicot-Cartsonis, Mathilda S.
AU - Digbeu, Biai D.E.
AU - Raji, Mukaila A.
AU - Kuo, Yong Fang
N1 - Funding Information:
This work was supported by 2022 National Institute on Aging Sponsored Medical Student Training in Aging Research (MSTAR) program, UTMB Claude D. Pepper Older American Independence Center (OAIC), the Texas Resource Center on Minority Aging Research (Texas RCMAR), Data Management and Analysis Core for Comparative Effectiveness Research on Cancer in Texas (P30 AG024832, P30 AG059301, RP 210130).
Publisher Copyright:
© 2022, W. Montague Cobb-NMA Health Institute.
PY - 2022
Y1 - 2022
N2 - Background: Disparities in late-stage breast or colorectal cancer diagnosis in younger populations are associated with social determinants of health (SDOH; education, poverty, housing, employment). We hypothesized that, in older Medicare beneficiaries, disparities in late-stage cancer diagnosis between Hispanic, non-Hispanic Black (NHB), and non-Hispanic White (NHW) patients would be associated with SDOH, comorbidities, and primary care physician (PCP) access. Methods: We analyzed 2005–2017 Texas Cancer Registry data linked with Medicare data for patients aged ≥ 66 (n = 86,501). Variables included age at diagnosis, sex, comorbidities, poverty level, education, PCP, and relevant cancer screening within 1 year. Results: For breast cancer in women (Hispanic, n = 6380; NHW, n = 39,225; NHB, n = 4055), a fully adjusted model showed significantly higher odds of late-stage cancer diagnosis only in NHB patients (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.01–1.22) compared with NHW; adjustment for comorbidities and SDOH partially decreased the odds of late-stage diagnosis relative to NHWs. Interaction terms between race-ethnicity and poverty were not significant. For colorectal cancer, a fully adjusted multivariate model showed significantly higher odds of late-stage diagnosis only among NHBs (n = 3318, OR 1.29, 95% CI 1.19–1.40) relative to NHWs (n = 27,470); adjustment for SDOH partially decreased the odds of late-stage diagnosis in NHB patients. Interaction terms between race-ethnicity and poverty were not significant. Conclusion: Racial disparities in late-stage breast and colorectal cancer diagnoses remain after adjustment for SDOH and clinically relevant factors, underscoring the need to optimize access to screening and timely cancer treatment in racial/ethnic minorities.
AB - Background: Disparities in late-stage breast or colorectal cancer diagnosis in younger populations are associated with social determinants of health (SDOH; education, poverty, housing, employment). We hypothesized that, in older Medicare beneficiaries, disparities in late-stage cancer diagnosis between Hispanic, non-Hispanic Black (NHB), and non-Hispanic White (NHW) patients would be associated with SDOH, comorbidities, and primary care physician (PCP) access. Methods: We analyzed 2005–2017 Texas Cancer Registry data linked with Medicare data for patients aged ≥ 66 (n = 86,501). Variables included age at diagnosis, sex, comorbidities, poverty level, education, PCP, and relevant cancer screening within 1 year. Results: For breast cancer in women (Hispanic, n = 6380; NHW, n = 39,225; NHB, n = 4055), a fully adjusted model showed significantly higher odds of late-stage cancer diagnosis only in NHB patients (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.01–1.22) compared with NHW; adjustment for comorbidities and SDOH partially decreased the odds of late-stage diagnosis relative to NHWs. Interaction terms between race-ethnicity and poverty were not significant. For colorectal cancer, a fully adjusted multivariate model showed significantly higher odds of late-stage diagnosis only among NHBs (n = 3318, OR 1.29, 95% CI 1.19–1.40) relative to NHWs (n = 27,470); adjustment for SDOH partially decreased the odds of late-stage diagnosis in NHB patients. Interaction terms between race-ethnicity and poverty were not significant. Conclusion: Racial disparities in late-stage breast and colorectal cancer diagnoses remain after adjustment for SDOH and clinically relevant factors, underscoring the need to optimize access to screening and timely cancer treatment in racial/ethnic minorities.
KW - Bias
KW - Breast cancer
KW - Colorectal cancer
KW - Medicare
KW - Social determinants of health
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U2 - 10.1007/s40615-022-01491-4
DO - 10.1007/s40615-022-01491-4
M3 - Article
AN - SCOPUS:85144964603
JO - Journal of racial and ethnic health disparities
JF - Journal of racial and ethnic health disparities
SN - 2197-3792
ER -