title: Treatment disparities following the diagnosis of an astrocytoma.
abstract: Post-operative radiation and chemotherapy following diagnosis of astrocytoma are standard care. No research has examined racial or insurance-based disparities in treatment receipt. The purpose of this study was to evaluate whether African Americans and patients with dual eligibility in Medicare and Medicaid (DE), compared to Caucasians and patients with Medicare alone, experienced differences in (1) seeing a radiation oncologist, (2) receiving radiation or chemotherapy, and (3) overall survival. Using a retrospective descriptive design, statewide Medicaid and Medicare data were merged with the Michigan Tumor Registry to extract a sample of patients (n = 604) ≥ 65 years old with a first primary astrocytoma diagnosis in Michigan between 1996 and 2000. There were no racial or insurance-based differences in reporting a claim for a radiation oncologist. Controlling for age, income, surgical intervention, residence population, comorbidities, gender, and stage, African Americans were less likely to report radiation claims than Caucasians (OR = 0.20; 95% CI = 0.07-0.54). DE patients were less likely to report radiation claims (OR = 0.50; 95% CI = 0.26-0.94) than those with Medicare only. These differences were not seen with chemotherapy. When only those with a glioblastoma multiforme were examined, DE patients (OR = 0.47; 95% CI = 0.24-0.92) and African Americans (OR = 0.13; 95% CI = 0.04-0.44) were much less likely to report radiation claims. Race and insurance status did not significantly affect survival, although income did. Data suggest disparities in race and insurance status may exist in receiving standard of care for astrocytomas. Further research is warranted to replicate the data and determine potential sources for these disparities.
authors.affiliation: School of Nursing, University of Pittsburgh, Pittsburgh, PA 15261, USA. prs11@pitt.edu
authors.forename: Paula R
authors.initials: PR
authors.lastname: Sherwood
authors.forename: Bassam A
authors.initials: BA
authors.lastname: Dahman
authors.forename: Heidi S
authors.initials: HS
authors.lastname: Donovan
authors.forename: Arlan
authors.initials: A
authors.lastname: Mintz
authors.forename: Charles W
authors.initials: CW
authors.lastname: Given
authors.forename: Cathy J
authors.initials: CJ
authors.lastname: Bradley
mesh_terms: D001741:Black or African American; D001254:Astrocytoma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid; D006278:Medicare; D008824:Michigan / Q000453:epidemiology; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D059039:Standard of Care / Q000706:statistics & numerical data; D014481:United States; D044465:White People