title: Social service barriers delay care among women with abnormal cancer screening.
abstract: BACKGROUND
  Inequity in cancer outcomes for minorities and vulnerable populations has been linked to delays in cancer care that arise from barriers to accessing care. Social service barriers represent those obstacles related to meeting life's most basic needs, like housing and income, which are often supported by public policy, regulation and services.
  
  
  OBJECTIVE
  To examine the association between social service barriers and timely diagnostic resolution after a cancer screening abnormality.
  
  
  METHODS
  Secondary analysis of the intervention arm of Boston Patient Navigation Research Program (2007-2008) conducted across six urban community health centers. Subjects with no barriers, other barriers, and social service barriers were compared on their time to diagnostic resolution.
  
  
  METHODS
  Women ≥ 18 years of age with a breast or cervical cancer screening abnormality.
  
  
  METHODS
  Social service barriers included: income supports, housing and utilities, education and employment, and personal/family stability and safety. Time to event analyses compared across five groups: those with no barriers, one barrier (other), one barrier (social service), two or more barriers (all other), and two or more barriers (at least one social service).
  
  
  RESULTS
  1,481 navigated women; 31 % Hispanic, 27 % Black, 32 % White; 37 % non-English speakers and 28 % had private health insurance. Eighty-eight women (6 %) had social service barriers. Compared to those without social service barriers, those with were more likely to be Hispanic, younger, have public/no health insurance, and have multiple barriers. Those with two or more barriers (at least one social service barrier), had the longest time to resolution compared to the other four groups (aHR resolution < 60 days = 0.27, ≥ 60 days = 0.37).
  
  
  CONCLUSIONS
  Vulnerable women with multiple barriers, when at least one is a social service barrier, have delays in care despite navigation. The impact of patient navigation may never be fully realized if social service barriers persist without being identified or addressed.
authors.affiliation: Women's Health Unit, Section of General Internal Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, 801 Massachusetts Avenue, 1st floor, Boston, MA, 02118-2526, USA, swprim03@gmail.com.
authors.forename: Sarah W
authors.initials: SW
authors.lastname: Primeau
authors.forename: Karen M
authors.initials: KM
authors.lastname: Freund
authors.forename: Ambili
authors.initials: A
authors.lastname: Ramachandran
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Bak
authors.forename: Timothy
authors.initials: T
authors.lastname: Heeren
authors.forename: Clara A
authors.initials: CA
authors.lastname: Chen
authors.forename: Samantha
authors.initials: S
authors.lastname: Morton
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Battaglia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis; D003151:Community Health Centers / Q000458:organization & administration; D055088:Early Detection of Cancer; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000379:methods; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008404:Massachusetts; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data; D062526:Patient Navigation; D012947:Social Work / Q000458:organization & administration* / Q000706:statistics & numerical data; D013997:Time Factors; D019037:Urban Health Services / Q000458:organization & administration; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis; D055815:Young Adult