Dissertation
Racial-ethnic disparities along the continuum of breast cancer care: treatment quality and survival
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Autumn 2022
DOI: 10.25820/etd.006790
Abstract
Background. Despite lower incidence of breast cancer among Black and American Indian/Alaska Native (AIAN) women, Black and AIAN women are more likely to die from the disease than non-Hispanic Whites (NHW). Differences in treatment quality contribute to these survival disparities. The purpose of this dissertation was to characterize racial-ethnic differences in quality along the continuum of breast cancer care from diagnosis through end of life.
Methods. We performed three studies using the Surveillance, Epidemiology, and End Results (SEER) Program data linked with Medicare Fee-For-Service (FFS) insurance claims. In the first study, we described patterns of care by race-ethnicity in terms of the individual evidence-based services recommended by clinical practice guidelines and established quality metrics. In the second study, we examined racial-ethnic disparities in guideline-concordance in the context of where patients seek care and where they live using multilevel modeling. In the final study, we explored the role of guideline-recommended care in racial-ethnic differences in survival at one- and five-years from breast cancer diagnosis.
Results. Black and AIAN women were consistently less likely to receive the standard of breast cancer care compared to NHW from diagnosis through first-line treatment. Patients treated at better resourced facilities were more likely to receive guideline-recommended care, while residence in medically underserved areas (e.g., racially segregated) was associated with lower quality care. Black and AIAN women had increased risk of death at one- and five-years after their breast cancer diagnosis. However, survival disparities were more affected by baseline comorbidity and frailty than by differences in treatment quality.
Conclusions. Racial-ethnic disparities in quality of care begin early in the clinical course; efforts to equitably deliver high-quality treatment must include equitable delivery of recommended diagnostics and clinical workup procedures. However, improving access to high-quality care without simultaneously addressing the social and structural root causes of disparities in health, healthcare, and patient outcomes may not ameliorate racial-ethnic survival disparities.
Details
- Title: Subtitle
- Racial-ethnic disparities along the continuum of breast cancer care: treatment quality and survival
- Creators
- Emma Herbach
- Contributors
- Mary Charlton (Advisor)Sarah Nash (Committee Member)Ryan M Carnahan (Committee Member)Ingrid Lizarraga (Committee Member)Michaela Curran (Committee Member)Kai Wang (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Epidemiology
- Date degree season
- Autumn 2022
- Publisher
- University of Iowa
- DOI
- 10.25820/etd.006790
- Number of pages
- ix, 184 pages
- Copyright
- Copyright 2022 Emma Herbach
- Language
- English
- Description illustrations
- Charts, graphs, tables
- Description bibliographic
- Includes bibliographical references (pages 143-153).
- Public Abstract (ETD)
Black and American Indian/Alaska Native (AIAN) women are less likely to get breast cancer, but more likely to die from it than non-Hispanic White (NHW) women. We know racial-ethnic disparities in breast cancer survival are related to access to high-quality care, but research is limited.
In this dissertation, we examine racial-ethnic differences in quality breast cancer care from the time a patient first arrives in the doctor’s office through the end of their life. First, we looked at racial-ethnic differences in all the services a patient should get to diagnose and treat breast cancer. Next, we examined if healthcare facilities patients are treated at or where they live lead to differences in quality of cancer care. In the last study, we studied if differences in high-quality healthcare created disparities in dying from breast cancer.
Black and AIAN women were less likely to get the recommended breast cancer care than NHW starting when they were diagnosed through starting treatment. Where patients went for their cancer care and where they lived were important for getting high-quality breast cancer care. Black and AIAN women were more likely to die after their diagnosis than NHW women, but this was more related to their health before they got cancer than the quality of breast cancer care.
To help women of all races and ethnicities with breast cancer live as long as possible, we need to meet all of their needs, even if seemingly unrelated to their cancer care such as transportation and affordable, healthy foods.
- Academic Unit
- Epidemiology
- Record Identifier
- 9984362557502771
Metrics
3 File views/ downloads
19 Record Views