title: Decomposing differences in medical care access among cancer survivors by race and ethnicity.
abstract: More research is needed to identify factors that explain why minority cancer survivors ages 18 to 64 are more likely to delay or forgo care when compared with whites. Data were merged from the 2000-2011 National Health Interview Survey to identify 12 125 adult survivors who delayed medical care. The Fairlie decomposition technique was applied to explore contributing factors that explain the differences. Compared with whites, Hispanics were more likely to delay care because of organizational barriers (odds ratio = 1.38; P < .05), and African Americans were more likely to delay medical care or treatment because of transportation barriers (odds ratio = 1.54; P < .001). The predicted probability of not receiving timely care because of each barrier was lowest among minorities. Age, insurance, perceived health, comorbidity, nativity, and year were significant factors that contributed to the disparities. Although expanded insurance coverage through the Affordable Care Act is expected to increase access, organizational factors and transportation play a major role.
authors.affiliation: University of Maryland, College Park, MD cking@umd.edu.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: King
authors.affiliation: University of Maryland, College Park, MD.
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.affiliation: University of Maryland, College Park, MD.
authors.forename: Rada K
authors.initials: RK
authors.lastname: Dagher
authors.affiliation: University of Maryland, College Park, MD.
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Holt
authors.affiliation: University of Maryland, College Park, MD.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D005260:Female; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000191:economics / Q000208:ethnology* / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D009369:Neoplasms / Q000191:economics / Q000208:ethnology* / Q000628:therapy*; D058991:Patient Protection and Affordable Care Act; D017741:Survivors / Q000706:statistics & numerical data*; D014186:Transportation / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult
keywords: cancer; decomposition; disparities; ethnicity; race