Black, Hispanic women at higher risk for ED visits after breast cancer surgery
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Black and Hispanic women had a higher risk than white women for ED visits within 90 days after breast cancer surgery, according to a population-based study published in Breast Cancer Research and Treatment.
Disparities occurred among women who experienced both breast cancer-associated and non-breast cancer-associated events. They also persisted across health insurance types.
“ED utilization is an indicator of quality of and access to care. To our knowledge, this was the first study that examined population-based racial/ethnic disparities after breast cancer curative-intent surgery,” Caryn Lerman, PhD, director of USC Norris Comprehensive Cancer Center, told Healio.
Investigators assessed variation in ED visits after breast cancer surgery and health care-associated moderators of disparities among 151,229 women (62.6% white, 17.2% Hispanic, 13.4% Asian/Pacific Islander, 6.3% Black, 0.5% American Indian/Alaskan Native) in California. All women had been diagnosed with stage zero to stage III breast cancer between 2005 and 2013.
Researchers used logistic regression, controlling for clinical and sociodemographic factors, to estimate differences in odds of having at least one breast cancer-associated ED visit within 90 days after surgery.
Compared with white women, Hispanic women (adjusted OR [aOR] = 1.11; 95% CI, 1.04-1.18) and Black women (aOR = 1.38; 95% CI, 1.27-1.5) had a higher likelihood of an ED visit within 90 days of surgery. Asian/Pacific Islander women had a lower likelihood (aOR = 0.77; 95% CI, 0.71-0.84).
Researchers reported higher odds of an ED visit among women with Medicaid (aOR = 1.81; 95% CI, 1.69-1.95) or Medicare (aOR = 1.36; 95% CI, 1.24-1.5) vs. commercial insurance; this trend appeared particularly strong among white women (P < .0001 for interaction). In addition, all women who underwent surgery at an NCI-designated comprehensive cancer center (aOR = 0.48; 95% CI, 0.42-0.54) or at a for-profit hospital (aOR = 0.79; 95% CI, 0.73-0.87) had a decreased likelihood of an ED visit.
Researchers acknowledged that they could only study outcomes of women who underwent surgery at licensed surgical centers in California, as unlicensed surgical centers are not required to report data to the Office of Statewide Health Planning and Development.
“We are now studying the role of social determinants of health and biological factors on breast cancer recurrence in a multiethnic population of women who have completed treatment,” Lerman said.
For more information:
Caryn Lerman, PhD, can be reached at USC Norris Comprehensive Cancer Center, 1441 Eastlake Ave., Suite 8302L MC 9181 Los Angeles, CA 90089; email: caryn.lerman@med.usc.edu.
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