Effects of health insurance and race on breast carcinoma treatments and outcomes

BACKGROUND. The authors hypothesized that insurance payer and race would in fluence the care and outcomes for patients with breast carcinoma. METHODS. The authors examined treatments and adjusted risk of death (throug h 1997) for all incident cases of breast carcinoma occurring in Florida in 1994 (n = 11,113) by using state tumor registry data. RESULTS, Patients lacking health insurance were less likely to receive brea st-conserving surgery (BCS) compared with patients who had private health i nsurance. Among patients insured by Medicare, those belonging to a health m aintenance organization (HMO) were more likely to receive BCS but less like ly to receive radiation therapy after BCS. Non-Hispanic African Americans h ad higher mortality rates even when stage at diagnosis, insurance payer, an d treatment modalities used were adjusted in multivariate models (adjusted risk ratio [RR], 1.35; 95% confidence interval [CI], 1.12-1.61; P = 0.001). Patients who had HMO insurance had similar survival rates compared with th ose with fee-for-service (FFS) insurance. Among non-Medicare patients, mort ality rates were higher for patients who had Medicaid insurance (RR, 1.58, 95% CI, 1.18-2.11; P = 0.002) and those who lacked health insurance (RR, 1. 31; 95% CI, 1.03-1.68: P = 0.03) compared with patients who had commercial FFS insurance. There were no insurance-related differences in survival rate s, however, once stage at diagnosis was controlled. CONCLUSIONS. As a result of later stage at diagnosis, patients with breast carcinoma who were uninsured, or insured by Medicaid, had higher mortality rates. Mortality rates were also higher among non-Hispanic African American s, a finding that was not fully explained by differences in stage at diagno sis, treatment modalities used, or insurance payer. Cancel 2000;89:2202-13. (C) 2000 American Cancer Society.