title: Having health insurance does not eliminate race/ethnicity-associated delays in breast cancer diagnosis in the District of Columbia.
abstract: BACKGROUND
  Delays in follow-up after breast cancer screening contribute to disparities in breast cancer outcomes. The objective of this research was to determine the impact of race/ethnicity and health insurance on diagnostic time, defined as number of days from suspicious finding to diagnostic resolution.
  
  
  METHODS
  This retrospective cohort study of 1538 women examined for breast abnormalities between 1998-2010 at 6 hospitals/clinics in the District of Columbia measured mean diagnostic times between non-Hispanic whites (NHWs), non-Hispanic blacks (NHBs), and Hispanics with private, government, or no health insurance by using a full-factorial ANOVA model.
  
  
  RESULTS
  Respective average--geometric mean (95% CI)--diagnostic times (in days) for NHWs, NHBs, and Hispanics were 16 (12, 21), 27 (23, 33), and 51 (35, 76) among privately insured; 12 (7, 19), 39 (32, 48), and 71 (48, 105) among government insured; 45 (17, 120), 60 (39, 92), and 67 (56, 79) among uninsured. Government insured NHWs had significantly shorter diagnostic times than government insured NHBs (P = .0003) and Hispanics (P < .0001). Privately insured NHWs had significantly shorter diagnostic times than privately insured NHBs (P = .03) and Hispanics (P < .0001). Privately insured NHBs had significantly shorter diagnostic times than uninsured NHBs (P = .03).
  
  
  CONCLUSIONS
  Insured minorities waited >2 times longer to reach their diagnostic resolution than insured NHWs. Having private health insurance increased the speed of diagnostic resolution in NHBs; however, their diagnostic time remained significantly longer than for privately insured NHWs. These results suggest diagnostic delays in minorities are more likely caused by other barriers associated with race/ethnicity than by insurance status.
authors.affiliation: Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, Washington, District of Columbia 20037, USA. hhoffman@gwu.edu
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Hoffman
authors.forename: Nancy L
authors.initials: NL
authors.lastname: LaVerda
authors.forename: Paul H
authors.initials: PH
authors.lastname: Levine
authors.forename: Heather A
authors.initials: HA
authors.lastname: Young
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Alexander
authors.forename: Steven R
authors.initials: SR
authors.lastname: Patierno
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D001943:Breast Neoplasms / Q000175:diagnosis / Q000208:ethnology*; D015331:Cohort Studies; D004219:District of Columbia; D055088:Early Detection of Cancer; D005006:Ethnicity; D005260:Female; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D007348:Insurance, Health; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D044465:White People; D001741:Black or African American