title: Barriers to and delays in accessing breast cancer care among New Zealand women: disparities by ethnicity.
abstract: BACKGROUND
  Unequal access to health care contributes to disparities in cancer outcomes. We examined the ethnic disparity in barriers to accessing primary and specialist health care experienced by New Zealand women with breast cancer.
  
  
  METHODS
  Women diagnosed with a primary invasive breast cancer between 2005 and 2007 were eligible. There were 1,799 respondents, n = 302 Māori (the indigenous population of NZ), n = 70 Pacific and n = 1,427 non-Māori/non-Pacific women. Participants completed a questionnaire listing 12 barriers grouped into three domains for analysis: personal; practical; and health care process factors, and reported the number of days between seeing a primary and a specialist care provider. Chi-squared, Fisher exact tests and logistic regression were used to assess uni- and multivariable differences in prevalence between ethnic groupings.
  
  
  RESULTS
  The prevalence of reporting three or more barriers was 18% among Pacific, 10% among Māori and 3% among non-Māori/non-Pacific women (P <0.001). The most commonly reported barriers were fear (Māori women) and cost (Pacific and non-Māori/non-Pacific women). Ethnic differences in reported barriers were not explained by deprivation or diabetes prevalence. Women with diabetes reported a two-fold higher risk of experiencing barriers to care compared to those without diabetes (odds ratio [OR]: 2.06, 95%CI 1.20 to 3.57). Māori and Pacific women were more likely to face delays (median 14 days) in seeing a specialist than non-Māori/non-Pacific women (median 7 days); these differences were not explained by the reported barriers.
  
  
  CONCLUSIONS
  Patterns of reported barriers to care differed according to ethnicity and were not explained by deprivation, or presence of co-morbidity. Māori and Pacific women are more likely to experience barriers to breast cancer care compared to non- Māori/non-Pacific women. We identified two key barriers affecting care for Māori and Pacific women; (a) delays in follow-up, and (b) the impact of co-morbid conditions. Future New Zealand work needs to focus attention on health care process factors and improving the interface between primary and secondary care to ensure quality health care is realised for all women with breast cancer.
authors.affiliation: Centre for Public Health Research, Massey University, P O Box 756, Wellington, 6140, New Zealand. l.ellison-loschmann@massey.ac.nz.
authors.forename: Lis
authors.initials: L
authors.lastname: Ellison-Loschmann
authors.affiliation: Centre for Public Health Research, Massey University, P O Box 756, Wellington, 6140, New Zealand. r.t.firestone@massey.ac.nz.
authors.forename: Ridvan
authors.initials: R
authors.lastname: Firestone
authors.affiliation: University of Bristol, Tyndall Ave, Bristol, BS8 1TH, UK. la8977.2008@my.bristol.ac.uk.
authors.forename: Lucy
authors.initials: L
authors.lastname: Aquilina
authors.affiliation: Centre for Public Health Research, Massey University, P O Box 756, Wellington, 6140, New Zealand. mckenzief@fellows.iarc.fr.|The International Agency for Research on Cancer, 150 cours Albert Thomas, Lyon, France. mckenzief@fellows.iarc.fr.
authors.forename: Fiona
authors.initials: F
authors.lastname: McKenzie
authors.affiliation: Centre for Public Health Research, Massey University, P O Box 756, Wellington, 6140, New Zealand. m.gray@massey.ac.nz.
authors.forename: Michelle
authors.initials: M
authors.lastname: Gray
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Rd, Bristol, BS6 7TQ, UK. mona.jeffreys@bristol.ac.uk.
authors.forename: Mona
authors.initials: M
authors.lastname: Jeffreys
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000208:ethnology*; D015897:Comorbidity; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009520:New Zealand; D044382:Population Groups; D015995:Prevalence; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult