Can Regionalization of Care Reduce Socioeconomic Disparities in Breast Cancer Survival?
Can Regionalization of Care Reduce Socioeconomic Disparities in Breast Cancer Survival?
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DOI：
10.1097/mlr.0000000000001456
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发表时间：
2021-01
期刊：
影响因子：
3
通讯作者：
Pezzin LE
中科院分区：
文献类型：
--
作者：
Nattinger AB;Rademacher N;McGinley EL;Bickell NA;Pezzin LE
低社会经济地位(SES)的乳腺癌患者的存活率比更富裕的女性更差，也更有可能在低容量设施中接受手术。由于在大容量设施治疗的乳腺癌患者有更好的生存，将低SES患者的护理划分到大容量设施可能会减少SES在生存方面的差异。我们利用纽约州的一项自然实验来检查一项政策，该政策排除了为在低容量设施接受手术的纽约医疗补助受益人支付乳腺癌手术费用的政策是否导致了SES死亡率差异的降低。多变量差异性回归分析比较了低SES(双重参保者，Medicare-Medicaid)乳腺癌患者和较富裕患者(仅限Medicare)在政策实施前后的一段时间内的死亡率。2006-2008年或2014-2015年共有14,183名患有乳腺癌的联邦医疗保险受益人。诊断后3年的全因死亡率和医疗补助状况，由医疗保险管理数据确定。在政策实施后，低SES和仅接受医疗保险的患者的3年生存率都较好。然而，低SES妇女的死亡率下降幅度比其他妇女更大，导致在根据年龄、种族和并存疾病进行调整后，政策实施后SES生存差距缩小了53%。远离低容量中心的早期乳腺癌护理的区域化可能会改善结果并减少SES在生存方面的差异。
Breast cancer patients of low socioeconomic status (SES) have worse survival than more affluent women and are also more likely to undergo surgery in low-volume facilities. Since breast cancer patients treated in high-volume facilities have better survival, regionalizing the care of low SES patients toward high-volume facilities might reduce SES disparities in survival. We leverage a natural experiment in New York state to examine whether a policy precluding payment for breast cancer surgery for New York Medicaid beneficiaries undergoing surgery in low-volume facilities led to reduced SES disparities in mortality. A multivariable difference-in-differences regression analysis compared mortality of low SES (dual enrollees, Medicare-Medicaid) breast cancer patients to that of wealthier patients exempt from the policy (Medicare only) for time periods before and after the policy implementation. A total of 14,183 Medicare beneficiaries with breast cancer in 2006–2008 or 2014–2015. All-cause mortality at 3 years after diagnosis and Medicaid status, determined by Medicare administrative data. Both low SES and Medicare-only patients had better 3-year survival after the policy implementation. However, the decline in mortality was larger in magnitude among the low SES women than others, resulting in a 53% smaller SES survival disparity after the policy after adjustment for age, race, and comorbid illness. Regionalization of early breast cancer care away from low-volume centers may improve outcomes and reduce SES disparities in survival.