Area-level poverty is associated with greater risk of ambulatory-care-sensitive hospitalizations in older breast cancer survivors

Mario Schootman; Donna B Jeffe; Min Lian; Anjali D Deshpande; William E Gillanders; Rebecca Aft; Walton Sumner

doi:10.1111/j.1532-5415.2008.02002.x

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Journal article

Area-level poverty is associated with greater risk of ambulatory-care-sensitive hospitalizations in older breast cancer survivors

Mario Schootman, Donna B Jeffe, Min Lian, Anjali D Deshpande, William E Gillanders, Rebecca Aft and Walton Sumner

Journal of the American Geriatrics Society (JAGS), Vol.56(12), pp.2180-2187

12/2008

DOI: 10.1111/j.1532-5415.2008.02002.x

PMCID: PMC2735731

PMID: 19093916

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Abstract

To estimate the frequency of ambulatory care-sensitive hospitalizations (ACSHs) and to compare the risk of ACSH in breast cancer survivors living in high-poverty with that of those in low-poverty areas. Prospective, multilevel study. National, population-based 1991 to 1999 National Cancer Institute Surveillance, Epidemiology, and End Results Program data linked with Medicare claims data throughout the United States. Breast cancer survivors aged 66 and older. ACSH was classified according to diagnosis at hospitalization. The percentage of the population living below the U.S. federal poverty line was calculated at the census-tract level. Potential confounders included demographic characteristics, comorbidity, tumor and treatment factors, and availability of medical care. Of 47,643 women, 13.3% had at least one ACSH. Women who lived in high-poverty census tracts (>or=30% poverty rate) were 1.5 times (95% confidence interval (CI)=1.34-1.72) as likely to have at least one ACSH after diagnosis as women who lived in low-poverty census tracts (<10% poverty rate). After adjusting for most confounders, results remained unchanged. After adjustment for comorbidity, the hazard ratio (HR) was reduced to 1.34 (95% CI=1.18-1.52), but adjusting for all variables did not further reduce the risk of ACSH associated with poverty rate beyond adjustment for comorbidity (HR=1.37, 95% CI=1.19-1.58). Elderly breast cancer survivors who lived in high-poverty census tracts may be at increased risk of reduced posttreatment follow-up care, preventive care, or symptom management as a result of not having adequate, timely, and high-quality ambulatory primary care as suggested by ACSH.

Breast Neoplasms - therapy

Poverty

Prospective Studies

Humans

Risk Factors

Survivors

Aged, 80 and over

Hospitalization - statistics & numerical data

Female

Aged

Ambulatory Care - statistics & numerical data

Continuity of Patient Care - statistics & numerical data

Details

Title: Subtitle: Area-level poverty is associated with greater risk of ambulatory-care-sensitive hospitalizations in older breast cancer survivors
Creators: Mario Schootman - Department of Medicine, Division of Health Bhavioral Research, Barnes-Jewish Hospital, Washington University School of Medicine, St Louis, Missouri 63108, USA. mschootm@im.wustl.edu
Donna B Jeffe
Min Lian
Anjali D Deshpande
William E Gillanders
Rebecca Aft
Walton Sumner
Resource Type: Journal article
Publication Details: Journal of the American Geriatrics Society (JAGS), Vol.56(12), pp.2180-2187
DOI: 10.1111/j.1532-5415.2008.02002.x
PMID: 19093916
PMCID: PMC2735731
NLM abbreviation: J Am Geriatr Soc
ISSN: 0002-8614
eISSN: 1532-5415
Publisher: Wiley; United States
Grant note: P30 CA091842 / NCI NIH HHS R01 CA100760-03 / NCI NIH HHS P30 CA091842-06 / NCI NIH HHS R01 CA100760 / NCI NIH HHS CA100760 / NCI NIH HHS CA9184206 / NCI NIH HHS
Language: English
Date published: 12/2008
Academic Unit: Epidemiology
Record Identifier: 9983995022702771

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