title: The effect of race/ethnicity and insurance in the administration of standard therapy for local breast cancer in Florida.
abstract: OBJECTIVE
  Assess the effect of race/ethnicity and insurance coverage on the receipt of standard treatment for local breast cancer.
  
  
  METHODS
  Local breast cancers diagnosed between July 1997 and December 2000 and reported to Florida's registry were linked to the Agency of Healthcare Administration inpatient and outpatient databases, resulting in 23,817 female local breast cancers with informative treatment. Standard treatment was defined as mastectomy or breast-conserving surgery followed by radiation therapy and it was modeled as a function of health insurance and race/ethnicity accounting for age at diagnosis, marital status and facility type.
  
  
  RESULTS
  Approximately 88% of the local breast cancers received standard treatment. The likelihood of standard treatment decreased by 3% per year of increase in the age at diagnosis. Compared to white non-Hispanic, black non-Hispanic women were 19% less likely to receive standard treatment (OR=0.81, 95%CI=0.68, 0.97) and Hispanics were 23% less likely (OR=0.77, 95%CI=0.66, 0.89). Local breast cancers diagnosed in non-teaching facilities were 21% more likely to receive standard treatment compared to those diagnosed in teaching facilities (OR=1.21; 95%CI=1.05, 1.38)). Compared to single, married women were 51% more likely to get standard treatment (OR=1.51, 95%CI=1.31, 1.66), followed by separated or divorced women that were 37% more likely (OR=1.37, 95%CI =1.13, 1.66). Compared to the privately insured, Medicare beneficiaries were 36% more likely to receive standard treatment (OR=1.36, 95%CI=1.22, 1.51) whereas the uninsured were 24% less likely (OR=0.76, 95%CI=0.59, 0.96); Medicaid insured women were 29% less likely to receive standard treatment compared to the uninsured (OR=0.71, 95%CI=0.53, 0.96).
  
  
  CONCLUSIONS
  Future efforts should target the elderly, Hispanic and black women, the uninsured, and those on Medicaid in order to reduce treatment disparities.
authors.affiliation: Florida Cancer Data System, Sylvester Cancer System, University of Miami, Miami, FL 33101, USA. lydia.voti@miami.edu
authors.forename: Lydia
authors.initials: L
authors.lastname: Voti
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Richardson
authors.forename: Isildinha
authors.initials: I
authors.lastname: Reis
authors.forename: Lora E
authors.initials: LE
authors.lastname: Fleming
authors.forename: Jill
authors.initials: J
authors.lastname: Mackinnon
authors.forename: Jan Willem W
authors.initials: JW
authors.lastname: Coebergh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000191:economics / Q000208:ethnology* / Q000628:therapy*; D005006:Ethnicity; D005260:Female; D005431:Florida / Q000453:epidemiology; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008875:Middle Aged
chemical_list: D000970:Antineoplastic Agents