Insurance Status Connects Racial Disparities in Early-Stage Breast Cancer Detection

Racial and ethnic disparities have long been a part of the early detection of breast cancer in women, but a new study finds that these disparities are also connected by a patient’s insurance coverage.
BY Conor Killmurray
PUBLISHED January 25, 2020
Insurance coverage connects nearly half of increased risk for late-stage breast cancer diagnoses seen among racial/ethnic minorities, demonstrating that insurance coverage plays a significant role in the ongoing disparities in outcomes, according to new research from JAMA Oncology.

“Compared with non-Hispanic White women, racial/ethnic minority women receive a diagnosis of breast cancer at a more advanced stage and have higher morbidity and mortality with breast cancer diagnosis,” the researchers explained. They believed that access to care through adequate insurance was associated with earlier diagnosis, and for women without this adequate insurance were more likely to have a breast cancer diagnosis with a much higher stage.

The researchers gathered data from the Surveillance, Epidemiology, and End Results (SEER) Program on 177,075 women, 40-64 years old, who received a diagnosis of stage 1 to 3 breast cancer between January 1, 2010, and December 31, 2016. Researchers’ primary outcome was the risk of women having a higher advanced stage at their breast cancer diagnosis. Mediation analyses were then conducted to look at the associations between race/ethnicity of patients and the connections between health insurance status and an earlier stage of diagnosis.

“Without insurance coverage, the lack of prevention, screening, and access to care, as well as delays in diagnosis lead to a later stage of disease at diagnosis and thus worse survival,” the researchers explained.

Initially, they found a higher proportion of women on Medicaid or uninsured had a diagnosis of stage 3 breast cancer compared to the women on health insurance (20% versus 11%). Broken down by observed racial/ethnic minority groups researchers found that Non-Hispanic Black women (17%), American Indian or Alaskan Native women (15%), and Hispanic women (16%), still had higher proportions of being diagnosed with stage 3 breast cancer compared to Non-Hispanic White women. 89% of the Non-Hispanic White women also had a higher proportion of insurance at the time of diagnosis. A higher proportion of Women uninsured at the time of diagnosis were also not married (58% vs 29%) to those insured and living in census tract areas that were in the lowest quintiles of median income, the highest percentage quintiles of adults with less than a high school education, and a higher proportion of these women were also living in language isolation.
  
When adjusted for health insurance factors 45%-47% of these racial differences in the risk of a higher stage breast cancer diagnosis was connected by health insurance. According to the researchers, all racial/ethnic minority women had anywhere between a double to quadruple higher odds of being uninsured at the time of their diagnosis compared to Non-Hispanic White Women.    

“Inadequate health insurance coverage also mediates the growing survivorship gap experienced by racial/ethnic minorities with cancer,” researchers concluded. “Thus, the negative effects of late-stage cancer are likely to have lasting repercussions for patients with cancer and their families.”
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