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Associations of Healthcare Affordability, Availability, and Accessibility with Quality Treatment Metrics in Patients with Ovarian Cancer.

Publication ,  Journal Article
Akinyemiju, TF; Wilson, LE; Diaz, N; Gupta, A; Huang, B; Pisu, M; Deveaux, A; Liang, M; Previs, RA; Moss, HA; Joshi, A; Ward, KC; Berchuck, A ...
Published in: Cancer Epidemiol Biomarkers Prev
July 1, 2022

BACKGROUND: Differential access to quality care is associated with racial disparities in ovarian cancer survival. Few studies have examined the association of multiple healthcare access (HCA) dimensions with racial disparities in quality treatment metrics, that is, primary debulking surgery performed by a gynecologic oncologist and initiation of guideline-recommended systemic therapy. METHODS: We analyzed data for patients with ovarian cancer diagnosed from 2008 to 2015 in the Surveillance, Epidemiology, and End Results-Medicare database. We defined HCA dimensions as affordability, availability, and accessibility. Modified Poisson regressions with sandwich error estimation were used to estimate the relative risk (RR) for quality treatment. RESULTS: The study cohort was 7% NH-Black, 6% Hispanic, and 87% NH-White. Overall, 29% of patients received surgery and 68% initiated systemic therapy. After adjusting for clinical variables, NH-Black patients were less likely to receive surgery [RR, 0.83; 95% confidence interval (CI), 0.70-0.98]; the observed association was attenuated after adjusting for healthcare affordability, accessibility, and availability (RR, 0.91; 95% CI, 0.77-1.08). Dual enrollment in Medicaid and Medicare compared with Medicare only was associated with lower likelihood of receiving surgery (RR, 0.86; 95% CI, 0.76-0.97) and systemic therapy (RR, 0.94; 95% CI, 0.92-0.97). Receiving treatment at a facility in the highest quartile of ovarian cancer surgical volume was associated with higher likelihood of surgery (RR, 1.12; 95% CI, 1.04-1.21). CONCLUSIONS: Racial differences were observed in ovarian cancer treatment quality and were partly explained by multiple HCA dimensions. IMPACT: Strategies to mitigate racial disparities in ovarian cancer treatment quality must focus on multiple HCA dimensions. Additional dimensions, acceptability and accommodation, may also be key to addressing disparities.

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Published In

Cancer Epidemiol Biomarkers Prev

DOI

EISSN

1538-7755

Publication Date

July 1, 2022

Volume

31

Issue

7

Start / End Page

1383 / 1393

Location

United States

Related Subject Headings

  • White People
  • United States
  • Ovarian Neoplasms
  • Medicare
  • Humans
  • Healthcare Disparities
  • Female
  • Epidemiology
  • Costs and Cost Analysis
  • Carcinoma, Ovarian Epithelial
 

Citation

APA
Chicago
ICMJE
MLA
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Akinyemiju, T. F., Wilson, L. E., Diaz, N., Gupta, A., Huang, B., Pisu, M., … Potosky, A. L. (2022). Associations of Healthcare Affordability, Availability, and Accessibility with Quality Treatment Metrics in Patients with Ovarian Cancer. Cancer Epidemiol Biomarkers Prev, 31(7), 1383–1393. https://doi.org/10.1158/1055-9965.EPI-21-1227
Akinyemiju, Tomi F., Lauren E. Wilson, Nicole Diaz, Anjali Gupta, Bin Huang, Maria Pisu, April Deveaux, et al. “Associations of Healthcare Affordability, Availability, and Accessibility with Quality Treatment Metrics in Patients with Ovarian Cancer.Cancer Epidemiol Biomarkers Prev 31, no. 7 (July 1, 2022): 1383–93. https://doi.org/10.1158/1055-9965.EPI-21-1227.
Akinyemiju TF, Wilson LE, Diaz N, Gupta A, Huang B, Pisu M, et al. Associations of Healthcare Affordability, Availability, and Accessibility with Quality Treatment Metrics in Patients with Ovarian Cancer. Cancer Epidemiol Biomarkers Prev. 2022 Jul 1;31(7):1383–93.
Akinyemiju, Tomi F., et al. “Associations of Healthcare Affordability, Availability, and Accessibility with Quality Treatment Metrics in Patients with Ovarian Cancer.Cancer Epidemiol Biomarkers Prev, vol. 31, no. 7, July 2022, pp. 1383–93. Pubmed, doi:10.1158/1055-9965.EPI-21-1227.
Akinyemiju TF, Wilson LE, Diaz N, Gupta A, Huang B, Pisu M, Deveaux A, Liang M, Previs RA, Moss HA, Joshi A, Ward KC, Schymura MJ, Berchuck A, Potosky AL. Associations of Healthcare Affordability, Availability, and Accessibility with Quality Treatment Metrics in Patients with Ovarian Cancer. Cancer Epidemiol Biomarkers Prev. 2022 Jul 1;31(7):1383–1393.

Published In

Cancer Epidemiol Biomarkers Prev

DOI

EISSN

1538-7755

Publication Date

July 1, 2022

Volume

31

Issue

7

Start / End Page

1383 / 1393

Location

United States

Related Subject Headings

  • White People
  • United States
  • Ovarian Neoplasms
  • Medicare
  • Humans
  • Healthcare Disparities
  • Female
  • Epidemiology
  • Costs and Cost Analysis
  • Carcinoma, Ovarian Epithelial