title: Racial/Ethnic differences in receipt of timely adjuvant therapy for older women with breast cancer: are delays influenced by the hospitals where patients obtain surgical care?
abstract: OBJECTIVE
  To examine whether hospitals where patients obtain care explain racial/ethnic differences in treatment delay.
  
  
  METHODS
  Surveillance, Epidemiology, and End Results data linked with Medicare claims.
  
  
  METHODS
  We examined delays in adjuvant chemotherapy or radiation for women diagnosed with stage I-III breast cancer during 1992-2007. We used multivariable logistic regression to assess the probability of delay by race/ethnicity and included hospital fixed effects to assess whether hospitals explained disparities.
  
  
  RESULTS
  Among 54,592 women, black (11.9 percent) and Hispanic (9.9 percent) women had more delays than whites (7.8 percent, p < .0001). After adjustment, black (vs. white) women had higher odds of delay (odds ratio = 1.25, 95 percent confidence interval = 1.10-1.42), attenuated somewhat by including hospital fixed effects (OR = 1.17, 95 percent CI = 1.02-1.33).
  
  
  CONCLUSIONS
  Hospitals are the important contributors to racial disparities in treatment delay.
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Freedman
authors.forename: Yulei
authors.initials: Y
authors.lastname: He
authors.forename: Eric P
authors.initials: EP
authors.lastname: Winer
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000208:ethnology* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D018426:SEER Program; D013997:Time Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data*
keywords: Breast cancer; delays; disparities