title: Early diffusion of gene expression profiling in breast cancer patients associated with areas of high income inequality.
abstract: With the Affordable Care Act reducing coverage disparities, social factors could prominently determine where and for whom innovations first diffuse in health care markets. Gene expression profiling is a potentially cost-effective innovation that guides chemotherapy decisions in early-stage breast cancer, but adoption has been uneven across the United States. Using a sample of commercially insured women, we evaluated whether income inequality in metropolitan areas was associated with receipt of gene expression profiling during its initial diffusion in 2006-07. In areas with high income inequality, gene expression profiling receipt was higher than elsewhere, but it was associated with a 10.6-percentage-point gap between high- and low-income women. In areas with low rates of income inequality, gene expression profiling receipt was lower, with no significant differences by income. Even among insured women, income inequality may indirectly shape diffusion of gene expression profiling, with benefits accruing to the highest-income patients in the most unequal places. Policies reducing gene expression profiling disparities should address low-inequality areas and, in unequal places, practice settings serving low-income patients.
authors.affiliation: Ninez A. Ponce is a professor in the Department of Health Policy and Management at the Fielding School of Public Health, and associate center director of the UCLA Center for Health Policy Research, University of California, Los Angeles.
authors.forename: Ninez A
authors.initials: NA
authors.lastname: Ponce
authors.affiliation: Michelle Ko (Michelle.Ko@ucsf.edu) is a primary care research fellow at the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco.
authors.forename: Michelle
authors.initials: M
authors.lastname: Ko
authors.affiliation: Su-Ying Liang is a research economist at the Palo Alto Medical Foundation Research Institute, in Palo Alto, California.
authors.forename: Su-Ying
authors.initials: SY
authors.lastname: Liang
authors.affiliation: Joanne Armstrong is senior medical director and head of Women's Health at Aetna in Sugar Land, Texas.
authors.forename: Joanne
authors.initials: J
authors.lastname: Armstrong
authors.affiliation: Michele Toscano is director of Business Management Planning and Reporting and program manager for the Racial and Ethnic Initiative at Aetna.
authors.forename: Michele
authors.initials: M
authors.lastname: Toscano
authors.affiliation: Catherine Chanfreau-Coffinier is a graduate student in the Department of Health Policy and Management at the Fielding School of Public Health, University of California, Los Angeles.
authors.forename: Catherine
authors.initials: C
authors.lastname: Chanfreau-Coffinier
authors.affiliation: Jennifer S. Haas is a professor of medicine at Harvard University and Brigham and Women's Hospital, in Boston, Massachusetts.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000191:economics / Q000235:genetics* / Q000628:therapy; D005260:Female; D020869:Gene Expression Profiling / Q000191:economics*; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D008875:Middle Aged; D011203:Poverty; D014481:United States
keywords: Medical technology; breast cancer; genomics; income inequality; personalized medicine