title: Impact of Preexisting Mental Illnesses on Receipt of Guideline-Consistent Breast Cancer Treatment and Health Care Utilization.
abstract: This study determined the impact of preexisting mental illnesses on guideline-consistent breast cancer treatment and breast cancer-related health care utilization. This was a retrospective, longitudinal, cohort study conducted using data from the 2006-2008 Medicaid Analytic Extract files. The target population for the study consisted of female Medicaid enrollees who were aged 18-64 years and were newly diagnosed with breast cancer in 2007. Guideline-consistent breast cancer treatment was defined according to established guidelines. Breast cancer-related health care use was reported in the form of inpatient, outpatient, and emergency room visits. Statistical analyses consisted of multivariable hierarchical regression models. A total of 2142 newly diagnosed cases of breast cancer were identified. Approximately 38% of these had a preexisting mental illness. Individuals with any preexisting mental illness were less likely to receive guideline-consistent breast cancer treatment compared to those without any preexisting mental illness (adjusted odds ratio: 0.793, 95% confidence interval [CI]: 0.646-0.973). A negative association was observed between preexisting mental illness and breast cancer-related outpatient (adjusted incident rate ratio (AIRR): 0.917, 95% CI: 0.892-0.942) and emergency room utilization (AIRR: 0.842, 95% CI: 0.709-0.999). The association between preexisting mental illnesses and breast cancer-related inpatient utilization was statistically insignificant (AIRR: 0.993, 95% CI: 0.851-1.159). The findings of this study indicate that breast cancer patients with preexisting mental illnesses experience disparities in terms of receipt of guideline-consistent breast cancer treatment and health care utilization. The results of this study highlight the need for more focused care for patients with preexisting mental illness.
authors.affiliation: 1 Dickson Advanced Analytics, Carolinas Healthcare System , Charlotte, North Carolina.
authors.forename: Rohan
authors.initials: R
authors.lastname: Mahabaleshwarkar
authors.affiliation: 2 Department of Pharmacy Administration, School of Pharmacy, The University of Mississippi , University, Mississippi.
authors.forename: Rahul
authors.initials: R
authors.lastname: Khanna
authors.affiliation: 3 Center for Pharmaceutical Marketing and Management, School of Pharmacy, The University of Mississippi , University, Mississippi.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Banahan
authors.affiliation: 2 Department of Pharmacy Administration, School of Pharmacy, The University of Mississippi , University, Mississippi.
authors.forename: Donna
authors.initials: D
authors.lastname: West-Strum
authors.affiliation: 2 Department of Pharmacy Administration, School of Pharmacy, The University of Mississippi , University, Mississippi.
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
authors.affiliation: 4 Department of Social and Behavioral Sciences, College of Public Health, Kent State University , Kent, Ohio.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Hallam
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D019468:Disease Management; D005260:Female; D019983:Guideline Adherence; D006301:Health Services Needs and Demand; D006801:Humans; D008484:Medicaid / Q000191:economics; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology