Racial/Ethnic differences in receipt of timely adjuvant therapy for older women with breast cancer: are delays influenced by the hospitals where patients obtain surgical care?

OBJECTIVE: To examine whether hospitals where patients obtain care explain racial/ethnic differences in treatment delay. DATA SOURCE: Surveillance, Epidemiology, and End Results data linked with Medicare claims. STUDY
DESIGN: We examined delays in adjuvant chemotherapy or radiation for women diagnosed with stage I-III breast cancer during 1992-2007. We used multivariable logistic regression to assess the probability of delay by race/ethnicity and included hospital fixed effects to assess whether hospitals explained disparities. PRINCIPAL
FINDINGS: Among 54,592 women, black (11.9 percent) and Hispanic (9.9 percent) women had more delays than whites (7.8 percent, p < .0001). After adjustment, black (vs. white) women had higher odds of delay (odds ratio = 1.25, 95 percent confidence interval = 1.10-1.42), attenuated somewhat by including hospital fixed effects (OR = 1.17, 95 percent CI = 1.02-1.33).
CONCLUSIONS: Hospitals are the important contributors to racial disparities in treatment delay. © Health Research and Educational Trust.