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Roubidoux MA, Kaur JS, Rhoades DA. Health Disparities in Cancer Among American Indians and Alaska Natives. Acad Radiol 2022; 29:1013-1021. [PMID: 34802904 DOI: 10.1016/j.acra.2021.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 12/15/2022]
Abstract
American Indians and Alaska Natives (AI/AN) are underserved populations who suffer from several health disparities, 1 of which is cancer. Malignancies, especially cancers of the breast, liver, and lung, are common causes of death in this population. Health care disparities in this population include more limited access to diagnostic radiology because of geographic and/or health system limitations. Early detection of these cancers may be enabled by improving patient and physician access to medical imaging. Awareness by the radiology community of the cancer disparities among this population is needed to support research targeted to this specific ethnic group and to support outreach efforts to provide more imaging opportunities. Providing greater access to imaging facilities will also improve patient compliance with screening recommendations, ultimately improving mortality in these populations.
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Affiliation(s)
- Marilyn A Roubidoux
- Department of Radiology, Michigan Medicine, TC 2910, 1500 E. Medical Center Drive, Ann Arbor, Mi 48109-5326.
| | - Judith S Kaur
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida
| | - Dorothy A Rhoades
- Department of Internal Medicine, Stephenson Cancer Center and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Greer MD, Amiri S, Denney JT, Amram O, Halasz LM, Buchwald D. Disparities in Access to Radiation Therapy Facilities Among American Indians/Alaska Natives and Hispanics in Washington State. Int J Radiat Oncol Biol Phys 2022; 112:285-293. [PMID: 34715256 DOI: 10.1016/j.ijrobp.2021.08.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/29/2021] [Accepted: 08/25/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Racial and ethnic minorities in the state of Washington experience higher cancer mortality relative to whites. We sought to characterize differences in travel distance to radiation therapy (RT) facilities in Washington by race and ethnicity with a special focus on non-Hispanic American Indians and Alaska Natives as a contributor to limited access and cancer disparities. METHODS AND MATERIALS Geocoded mortality data from Washington Department of Health (2011-2018) were used to identify decedents with mortality related to all-causes, all cancers, and cancers likely requiring access to RT. This was determined from optimal RT usage estimates by diagnosis. RT facility locations were ascertained from the Directory of Radiation Therapy Centers and confirmed. Distance from decedents' address listed on death certificates to nearest RT facility was calculated. Generalized mixed models were used for statistical analysis. RESULTS We identified 418,754 deaths; 109,134 were cancer-related, 60,973 likely required RT. Among decedents with cancers likely requiring RT, non-Hispanic American Indians and Alaska Natives decedents would have had to travel 1.16 times (95% confidence interval [CI], 1.09-1.24) farther from their residences to reach the nearest treatment facility compared with non-Hispanic whites. This association existed in metro counties but was more pronounced in nonmetro counties (1.39 times farther; 95% CI, 1.22-1.58). In addition, Hispanics would have had to travel 1.11 times farther (95% CI, 1.06-1.16) to reach the nearest facility compared with non-Hispanic whites, primarily due to differences in urban counties. Decedents in nonmetro counties lived on average 35 miles (SD = 29) from RT centers and non-Hispanic American Indians and Alaska Natives in nonmetro counties 53 miles (SD = 38). Compared with non-Hispanic white decedents, those who were non-Hispanic black, non-Hispanic Asian, and non-Hispanic Native Hawaiian decedents lived closer to RT facilities. CONCLUSIONS We observed significant disparities in access to RT facilities in Washington, specifically for non-Hispanic American Indians and Alaska Natives and rural decedents. The findings call for initiatives to improve access to critical cancer treatment services for these underserved populations with known disparities in cancer deaths.
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Affiliation(s)
- Matthew D Greer
- Department of Radiation Oncology, University of Washington, Seattle, Washington.
| | - Solmaz Amiri
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington; Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, Washington
| | - Justin T Denney
- Department of Sociology, Washington State University, Pullman, Washington
| | - Ofer Amram
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - Lia M Halasz
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, Washington
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Balazy KE, Benitez CM, Gutkin PM, Karl JJ, Jacobson CE, von Eyben R, Horst KC. Impact of Insurance on Stage of Breast Cancer Presentation for Different Races and Ethnicities. JCO Oncol Pract 2021; 17:e603-e613. [PMID: 33974824 DOI: 10.1200/op.20.00950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Survival in breast cancer is largely stage-dependent. Lack of insurance and Medicaid have been associated with later-stage breast cancer, but it is unknown to what degree this association varies by race or ethnicity. METHODS We conducted a retrospective single-institution cohort analysis of women undergoing breast radiotherapy from 2012 to 2017 (n = 1,019). Patients were categorized as having private insurance (n = 540), Medicare (n = 332), Medicaid (n = 122), or self-pay (n = 25). Ordinal logistic regression analysis identified variables associated with later-stage presentation, including age, race or ethnicity, insurance, the interaction between insurance and race or ethnicity, body mass index, education, and language. RESULTS The association between insurance and breast cancer stage varied on the basis of a patient's race or ethnicity (P = .0114). White and Asian patients with Medicaid had significantly higher odds of later-stage breast cancer than those with private insurance (White odds ratio [OR], 2.10; 95% CI, 1.02 to 4.34; Asian OR, 3.22; 95% CI, 1.56 to 6.67). However, the inverse was true for Hispanic patients who had lower odds of later-stage disease with Medicaid than private insurance (OR, 0.36; 95% CI, 0.16 to 0.90). Hispanic patients with Medicaid had lower odds than either White or Asian patients with Medicaid. These findings persisted across all ages. CONCLUSION The association between insurance and later-stage presentation is significantly influenced by race or ethnicity. Medicaid was generally associated with later-stage breast cancer diagnosis, but this was not true across all races and ethnicities. Although White and Asian patients with Medicaid presented with later stage, Hispanic patients fared better with Medicaid than private insurance. Future work should investigate how Medicaid is successfully targeting Hispanic patients in breast cancer care.
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Affiliation(s)
- Katy E Balazy
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | | | | | - Jamie J Karl
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | | | - Rie von Eyben
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Kathleen C Horst
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
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McGrew KM, Peck JD, Vesely SK, Janitz AE, Snider CA, Dougherty TM, Campbell JE. Effect Modification of the Association Between Race and Stage at Colorectal Cancer Diagnosis by Socioeconomic Status. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25 Suppl 5, Tribal Epidemiology Centers: Advancing Public Health in Indian Country for Over 20 Years:S29-S35. [PMID: 31348188 PMCID: PMC7043013 DOI: 10.1097/phh.0000000000000993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To compare risks of distant-stage colorectal cancer (CRC) diagnosis between whites and American Indian/Alaska Natives (AI/ANs) and to explore effect modification by area-based socioeconomic status (SES). DESIGN Retrospective cohort study using data from the Oklahoma Central Cancer Registry. SETTING Oklahoma. PARTICIPANTS White and AI/AN cases of CRC diagnosed in Oklahoma between 2001 and 2008 (N = 8 438). A subanalysis was performed on the cohort of those aged 50 years and older (N = 7 728). MAIN OUTCOME MEASURE Risk of distant-stage CRC diagnosis stratified by SES score. RESULTS Race and SES were independently associated with distant-stage diagnosis. In SES-stratified analyses, AI/ANs in the 2 lowest SES groups experienced increased risks in the overall cohort and among those aged 50 years and older. In multivariable models, risks remained significant among those aged 50 years and older in the lowest SES groups (Adjusted risk ratio SES score of 2: 1.31, 95% confidence interval: 1.06-1.63 and adjusted risk ratio SES score of 1: 1.21, 95% confidence interval: 1.01-1.44). CONCLUSION Socioeconomic status is an effect modifier in the association between race/ethnicity and stage at CRC diagnosis. Disparities in stage at CRC diagnosis exist between AI/ANs and whites with lower estimated SES. Efforts are needed to increase CRC screening among lower SES AI/ANs.
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Affiliation(s)
- Kaitlin M. McGrew
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jennifer D. Peck
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Sara K. Vesely
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Amanda E. Janitz
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Cuyler A. Snider
- Oklahoma Area Tribal Epidemiology Center, Southern Plains Tribal Health Board, Oklahoma City, OK
| | - Tyler M. Dougherty
- Oklahoma Area Tribal Epidemiology Center, Southern Plains Tribal Health Board, Oklahoma City, OK
| | - Janis E. Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Keegan THM, Parsons HM, Chen Y, Maguire FB, Morris CR, Parikh-Patel A, Kizer KW, Wun T. Impact of Health Insurance on Stage at Cancer Diagnosis Among Adolescents and Young Adults. J Natl Cancer Inst 2020; 111:1152-1160. [PMID: 30937440 DOI: 10.1093/jnci/djz039] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/01/2019] [Accepted: 03/22/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Uninsured adolescents and young adults (AYAs) and those with publicly funded health insurance are more likely to be diagnosed with cancer at later stages. However, prior population-based studies have not distinguished between AYAs who were continuously uninsured from those who gained Medicaid coverage at the time of cancer diagnosis. METHODS AYA patients (ages 15-39 years) with nine common cancers diagnosed from 2005 to 2014 were identified using California Cancer Registry data. This cohort was linked to California Medicaid enrollment files to determine continuous enrollment, discontinuous enrollment, or enrollment at diagnosis, with other types of insurance determined from registry data. Multivariable logistic regression was used to evaluate factors associated with later stages at diagnosis. RESULTS The majority of 52 774 AYA cancer patients had private or military insurance (67.6%), followed by continuous Medicaid (12.4%), Medicaid at diagnosis (8.5%), discontinuous Medicaid (3.9%), other public insurance (1.6%), no insurance (2.9%), or unknown insurance (3.1%). Of the 13 069 with Medicaid insurance, 50.1% were continuously enrolled. Compared to those who were privately insured, AYAs who enrolled in Medicaid at diagnosis were 2.2-2.5 times more likely to be diagnosed with later stage disease, whereas AYAs discontinuously enrolled were 1.7-1.9 times and AYAs continuously enrolled were 1.4-1.5 times more likely to be diagnosed with later stage disease. Males, those residing in lower socioeconomic neighborhoods, and AYAs of Hispanic or black race and ethnicity (vs non-Hispanic white) were more likely to be diagnosed at a later stage, independent of insurance. CONCLUSIONS Our findings suggest that access to continuous medical insurance is important for decreasing the likelihood of late stage cancer diagnosis.
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Issaka RB, Li L, Fedorenko C, Ko CW, Inadomi JM, Ramsey SD. Racial Disparities in Colorectal Cancer Mortality: the Role of Endoscopy Wait-Time and Stage at Diagnosis. J Racial Ethn Health Disparities 2020; 7:967-974. [PMID: 32052305 DOI: 10.1007/s40615-020-00721-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In Western Washington (WA), colorectal cancer (CRC) mortality between 2012 and 2016 was highest in American Indian/Alaska Natives (AI/AN) and African-Americans (AA) at 20.7 and 18.7, respectively, compared with non-Hispanic Whites at 14.1/100,000 people. We hypothesized that time from billed encounters for CRC-associated symptoms to endoscopy completion or CRC stage at diagnosis contributed to observed differences. METHODS Using administrative insurance claims linked to WA cancer registry data, we performed a retrospective cohort study of patients diagnosed with CRC between 2011 and 2017, with continuous insurance for 15 months prior to diagnosis and a billed encounter for CRC-associated symptoms. We determined the wait-time (days) and stage at diagnosis and conducted logistic regression analysis to identify the factors associated with endoscopy completion. RESULTS Of the 3461 CRC patients identified, 57% had stage 2 or 3 disease with no differences in stage by race, and 84% completed an endoscopy after a billed encounter for CRC-associated symptoms. The median wait-time to endoscopy was 52 days (IQR 14-218) without differences by race. Compared with patients diagnosed with stage 1 CRC, patients with stage 4 CRC were more likely to complete an endoscopy within the first quartile of time (22.2% vs. 17.4%, p < 0.01). Living arrangement, insurance type, and comorbidity, but not race, were significant factors associated with endoscopy completion. CONCLUSIONS We found no statistically significant differences in time from billed CRC-associated symptoms to endoscopy completion or in CRC stage among AA and AI/AN compared to Whites. This suggests that other factors are more likely to contribute to observed mortality disparities.
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Affiliation(s)
- Rachel B Issaka
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M/S: M3-B232, Seattle, WA, 98109, USA. .,Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M/S: M3-B232, Seattle, WA, 98109, USA. .,Division of Gastroenterology, University of Washington School of Medicine, 1100 Fairview Ave. N., M/S: M3-B232, Seattle, WA, 98109, USA.
| | - Li Li
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M/S: M3-B232, Seattle, WA, 98109, USA
| | - Catherine Fedorenko
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M/S: M3-B232, Seattle, WA, 98109, USA
| | - Cynthia W Ko
- Division of Gastroenterology, University of Washington School of Medicine, 1100 Fairview Ave. N., M/S: M3-B232, Seattle, WA, 98109, USA
| | - John M Inadomi
- Division of Gastroenterology, University of Washington School of Medicine, 1100 Fairview Ave. N., M/S: M3-B232, Seattle, WA, 98109, USA
| | - Scott D Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M/S: M3-B232, Seattle, WA, 98109, USA
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