Racial differences in definitive breast cancer therapy in older women: are they explained by the hospitals where patients undergo surgery?
BACKGROUND
Prior research has documented racial disparities in patterns of care and outcomes for women with breast cancer.


OBJECTIVE
To assess whether black women receive care from lower-quality or lower-volume hospitals and if such differences explain disparities in receipt of definitive primary breast cancer therapy.


METHODS
Observational study of a population-based sample of breast cancer patients included in the SEER-Medicare database.


METHODS
Fifty five thousand four hundred seventy white or black women aged >65 diagnosed with stage I/II breast cancer during 1992-2002.


METHODS
Surgery at a high-quality hospital (top quartile rates of radiation after breast-conserving surgery) or high volume (top quartile) hospital and receipt of definitive primary therapy (mastectomy or breast-conserving surgery with radiation).


RESULTS
Black women were significantly less likely than white women to be treated at high-quality hospitals (adjusted odds ratio [OR] 0.60; 95% confidence interval [CI]: 0.40-0.87) but not high-volume hospitals (adjusted OR 0.85; 95% CI: 0.54-1.34). Black women were less likely than white women to receive definitive primary therapy, a finding partially explained by having surgery at a high-quality hospital but not by having surgery at a high-volume hospital.


CONCLUSIONS
Older black women were more likely than white women to undergo breast cancer surgery at hospitals with lower rates of radiation following breast-conserving surgery, and this explains some of the reported racial disparities previously observed in receipt of definitive therapy for early-stage breast cancer. Interventions to help hospitals treating large numbers of black women improve rates of radiation after breast-conserving surgery may help to decrease racial disparities in care.
Keating
Nancy L
NL
Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, 180 Longwood Avenue, Boston, MA 02115, USA. keating@hcp.med.harvard.edu
Kouri
Elena
E
He
Yulei
Y
Weeks
Jane C
JC
Winer
Eric P
EP
D001741:Black or African American / Q000208:ethnology / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000208:ethnology / Q000532:radiotherapy / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006302:Health Services Research; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008408:Mastectomy / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D018426:SEER Program; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000208:ethnology / Q000706:statistics & numerical data*