Samilia Obeng-Gyasi1, Lava Timsina2, Kathy D Miller3, Kandice K Ludwig2, Carla S Fisher2, David A Haggstrom4. 1. Indiana University School of Medicine, Department of Surgery, Indianapolis, IN. Electronic address: sobenggy@iupui.edu. 2. Indiana University School of Medicine, Department of Surgery, Indianapolis, IN. 3. Indiana University School of Medicine Division of Hematology and Oncology, Indianapolis, IN. 4. VA HSR&D Center for Health Information and Communication, Indianapolis, IN.
Abstract
BACKGROUND: The National Breast and Cervical Cancer Early Detection Program seeks to reduce health care disparities by providing uninsured and underinsured women access to screening mammograms. The objective of this study is to identify the differences in presentation, surgical management, and mortality among nonmetastatic uninsured patients diagnosed through Indiana's Breast and Cervical Cancer Program compared with patients with private and government (Medicare or Medicaid) insurance. METHODS: Study data were obtained using the Indiana state cancer registry and Indiana's Breast and Cervical Cancer Program. Women aged 50 to 64 with an index diagnosis of stage 0 to III breast cancer from January 1, 2006 to December 31, 2013, were included in the study. Bivariate intergroup analysis was conducted. Kaplan-Meier estimates between insurance types were compared using the log rank test. All-cause mortality was evaluated using a mixed effects model. RESULTS: The groups differed significantly for sociodemographic and clinical variables. Uninsured Indiana Breast and Cervical Cancer Program patients presented with later disease stage (P < .001) and had the highest overall mortality (hazard ratio 2.2, P = .003). Surgical management only differed among stage III patients (P = .012). CONCLUSION: To improve insurance-based disparities in Indiana, implementation of the Breast and Cervical Cancer Program in conjunction with expansion of insurance coverage to vulnerable low-income populations need to be optimized.
BACKGROUND: The National Breast and Cervical Cancer Early Detection Program seeks to reduce health care disparities by providing uninsured and underinsured women access to screening mammograms. The objective of this study is to identify the differences in presentation, surgical management, and mortality among nonmetastatic uninsured patients diagnosed through Indiana's Breast and Cervical Cancer Program compared with patients with private and government (Medicare or Medicaid) insurance. METHODS: Study data were obtained using the Indiana state cancer registry and Indiana's Breast and Cervical Cancer Program. Women aged 50 to 64 with an index diagnosis of stage 0 to III breast cancer from January 1, 2006 to December 31, 2013, were included in the study. Bivariate intergroup analysis was conducted. Kaplan-Meier estimates between insurance types were compared using the log rank test. All-cause mortality was evaluated using a mixed effects model. RESULTS: The groups differed significantly for sociodemographic and clinical variables. Uninsured Indiana Breast and Cervical Cancer Program patients presented with later disease stage (P < .001) and had the highest overall mortality (hazard ratio 2.2, P = .003). Surgical management only differed among stage III patients (P = .012). CONCLUSION: To improve insurance-based disparities in Indiana, implementation of the Breast and Cervical Cancer Program in conjunction with expansion of insurance coverage to vulnerable low-income populations need to be optimized.
Authors: Kristen E Rhodin; Cierra S Hong; Lindsey A Olivere; Elizabeth P Howell; Vinay K Giri; Kurren A Mehta; Taofik Oyekunle; Randall P Scheri; Betty C Tong; Julie A Sosa; Oluwadamilola M Fayanju Journal: J Surg Res Date: 2020-05-04 Impact factor: 2.192
Authors: Theresa Relation; Yaming Li; James L Fisher; Allan Tsung; Bridget Oppong; Mariam F Eskander; Samilia Obeng-Gyasi Journal: Surgery Date: 2021-11-30 Impact factor: 3.982
Authors: Irene Dankwa-Mullan; Judy George; M Christopher Roebuck; Joseph Tkacz; Van C Willis; Fredy Reyes; Yull E Arriaga Journal: Breast Cancer Res Treat Date: 2021-03-10 Impact factor: 4.872
Authors: Samilia Obeng-Gyasi; Sarah Asad; James L Fisher; Saurabh Rahurkar; Daniel G Stover Journal: Ann Surg Oncol Date: 2021-02-14 Impact factor: 4.339