Associations between health insurance status, neighborhood deprivation, and treatment delays in women with breast cancer living in Georgia.
Associations between health insurance status, neighborhood deprivation, and treatment delays in women with breast cancer living in Georgia.
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关于乳腺癌妇女的保险状况和治疗延迟之间的关联以及这种关联是否因社区社会经济剥夺状况而异，目前还知之甚少。在这项队列研究中，我们使用了2004年至2022年期间在格鲁吉亚的两个医疗保健系统诊断为乳腺癌的女性的病历数据。治疗延迟定义为距离手术>90天或距离全身治疗>120天。保险范围分为私人，医疗补助，医疗保险，其他公共或无保险。地区贫困指数（ADI）被用作社区社会经济地位的代表。采用逻辑回归分析延迟治疗与保险状态之间的关联，并使用交互作用项评估ADI的效应修正。在14,195名乳腺癌患者中，54%是非西班牙裔黑人，52%有私人保险。与私人保险的患者相比，那些没有保险，医疗补助计划登记者和医疗保险登记者的延迟治疗几率分别高出79%，75%和27（比值比[OR]：1.79，95%置信区间[CI]：1.32-2.43; OR：1.75，95% CI：1.43-2.13; OR：1.27，95% CI：1.06-1.51）。在生活在低贫困地区的患者中，那些没有保险的人，医疗补助计划登记者和医疗保险登记者比私人保险患者延迟治疗的几率高100%，84%和26（OR：2.00，95% CI：1.44-2.78; OR：1.84，95% CI：1.48-2.30; OR：1.26，95% CI：1.05-1.53）。在生活在高度贫困地区的患者中，未观察到不同保险状况的延迟治疗几率存在差异。保险状况与生活在低贫困社区的妇女的治疗延迟有关。然而，对于生活在高度贫困社区的妇女，无论保险状况如何，都观察到治疗延误。这项对生活在格鲁吉亚的乳腺癌妇女的研究表明，与私人保险的患者相比，医疗保险登记者、医疗补助登记者和未保险的患者治疗延迟的几率明显更高。生活在低贫困社区的患者，但生活在高贫困地区的患者，通过保险覆盖率观察到治疗延迟的几率存在显着差异。政策和干预措施应以保险覆盖面的公平为目标，以改善及时开始治疗。
Little is known regarding the association between insurance status and treatment delays in women with breast cancer and whether this association varies by neighborhood socioeconomic deprivation status. In this cohort study, we used medical record data of women diagnosed with breast cancer between 2004 and 2022 at two Georgia‐based healthcare systems. Treatment delay was defined as >90 days to surgery or >120 days to systemic treatment. Insurance coverage was categorized as private, Medicaid, Medicare, other public, or uninsured. Area deprivation index (ADI) was used as a proxy for neighborhood‐level socioeconomic status. Associations between delayed treatment and insurance status were analyzed using logistic regression, with an interaction term assessing effect modification by ADI. Of the 14,195 women with breast cancer, 54% were non‐Hispanic Black and 52% were privately insured. Compared with privately insured patients, those who were uninsured, Medicaid enrollees, and Medicare enrollees had 79%, 75%, and 27% higher odds of delayed treatment, respectively (odds ratio [OR]: 1.79, 95% confidence interval [CI]: 1.32–2.43; OR: 1.75, 95% CI: 1.43–2.13; OR: 1.27, 95% CI: 1.06–1.51). Among patients living in low–deprivation areas, those who were uninsured, Medicaid enrollees, and Medicare enrollees had 100%, 84%, and 26% higher odds of delayed treatment than privately insured patients (OR: 2.00, 95% CI: 1.44–2.78; OR: 1.84, 95% CI: 1.48–2.30; OR: 1.26, 95% CI: 1.05–1.53). No differences in the odds of delayed treatment by insurance status were observed in patients living in high‐deprivation areas. Insurance status was associated with treatment delays for women living in low‐deprivation neighborhoods. However, for women living in neighborhoods with high deprivation, treatment delays were observed regardless of insurance status. This study of women with breast cancer living in Georgia showed that patients who were Medicare enrollees, Medicaid enrollees, and uninsured had significantly higher odds of treatment delays compared to privately insured patients. Significant differences in odds of treatment delays by insurance coverage were observed for patients living in neighborhoods of low deprivation but not for those living in areas of high deprivation. Policy and interventions should target equity in insurance coverage to improve timely treatment initiation.
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