title: Racial differences in patterns of care among medicaid-enrolled patients with breast cancer.
abstract: OBJECTIVE
  Suboptimal care among minority and low-income patients may explain poorer survival. There is little information describing patterns of health care in Medicaid-insured women with breast cancer in the United States. Using a previously created and validated database linking Medicaid claims and state-wide tumor registry data, we describe patterns of breast cancer care within a low-income population.
  
  
  METHODS
  Sample characteristics were described by frequencies and means. Logistic regressions were used to determine predictors of type of surgery, use of radiation therapy after breast-conserving surgery (BCS), and use of adjuvant chemotherapy.
  
  
  RESULTS
  The sample consisted of 974 women. The dataset included only white (58%) and black (42%) women. Sixty-seven percent were treated with mastectomy; 43% received adjuvant chemotherapy; and 67% of women receiving BCS received adjuvant radiation. In multivariate analysis, predictors of BCS were young age, black race, and smaller tumor size. Furthermore, there was a trend toward more black than white women with tumors 4 cm or larger having BCS (18% v 8%; P = .06). Race was not related to use of adjuvant radiation therapy after BCS or to use of adjuvant chemotherapy.
  
  
  CONCLUSIONS
  In this group of patients with breast cancer enrolled in Medicaid, black women were more likely than white women to have BCS. Race was not associated with adjuvant radiation therapy or chemotherapy use. Factors affecting the quality of care delivered to low-income and minority patients are complex, and better care lies in exploring areas that need improvement.
authors.affiliation: Duke University Medical Center, Durham; Departments of Medicine, Surgery, and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Ohio State University, Columbus, OH.
authors.forename: Gretchen
authors.initials: G
authors.lastname: Kimmick
authors.forename: Fabian
authors.initials: F
authors.lastname: Camacho
authors.forename: Kristi Long
authors.initials: KL
authors.lastname: Foley
authors.forename: Edward A
authors.initials: EA
authors.lastname: Levine
authors.forename: Rajesh
authors.initials: R
authors.lastname: Balkrishnan
authors.forename: Roger
authors.initials: R
authors.lastname: Anderson