title: Breast Cancer among Women Living in Poverty: Better Care in Canada than in the United States.
abstract: This historical study estimated the protective effects of a universally accessible, single-payer health care system versus a multi-payer system that leaves many uninsured or underinsured by comparing breast cancer care of women living in high poverty neighborhoods in Ontario or California between 1996 and 2011. Women in Canada experienced better care particularly as compared to women who were inadequately insured in the United States. Women in Canada were diagnosed earlier (rate ratio [RR] = 1.12) and enjoyed better access to breast conserving surgery (RR = 1.48), radiation (RR = 1.60) and hormone therapies (RR = 1.78). Women living in high poverty Canadian neighborhoods even experienced shorter waits for surgery (RR = 0.58) and radiation therapy (RR = 0.44) than did such women in the US. Consequently, women in Canada were much more likely to survive longer. Regression analyses indicated that health insurance could explain most of the better care and better outcomes in Canada. Over this study's 15-year timeframe 31,500 late diagnoses, 94,500 sub-optimum treatment plans and 103,500 early deaths were estimated in high poverty US neighborhoods due to relatively inadequate health insurance coverage. Implications for social work practice, including advocacy for future reforms of US health care are discussed.
authors.affiliation: Professor, School of Social Work, University of Windsor, 401 Sunset Avenue, Windsor, Ontario, N9B 3P4, Canada; Telephone: 519 253-3000, ext. 3085.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Gorey
authors.affiliation: Research Associate, School of Social Work, University of Windsor.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Richter
authors.affiliation: Associate Professor and Canada Research Chair, Department of Geography, University of Western Ontario, London, Ontario.
authors.forename: Isaac N
authors.initials: IN
authors.lastname: Luginaah
authors.affiliation: Medical Oncologist, Windsor Regional Cancer Center, and Assistant Professor, School of Medicine and Dentistry, Department of Medicine, Division of General Internal Medicine, University of Western Ontario, London, Ontario.
authors.forename: Caroline
authors.initials: C
authors.lastname: Hamm
authors.affiliation: Professor, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Holowaty
authors.affiliation: Associate Professor, Department of Epidemiology and Biostatistics, University of Western Ontario and Scientist, Robarts Research Institute, London, Ontario.
authors.forename: GuangYong
authors.initials: G
authors.lastname: Zou
authors.affiliation: Statistician and Research Associate, School of Social Work, University of Windsor.
authors.forename: Madhan K
authors.initials: MK
authors.lastname: Balagurusamy
keywords: Affordable Care Act; breast cancer; health care reform; health insurance; poverty; single-payer system