Racial/Ethnic Disparities in Time to a Breast Cancer Diagnosis The Mediating Effects of Health Care Facility Factors

BACKGROUND:Racial/ethnic disparities exist along the breast cancer continuum, including time to a diagnosis. Previous research has largely focused on patient-level factors, and less is known about the role that health care facilities may play in delayed breast cancer care. OBJECTIVES:We examined rac...

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Published in:Medical care Vol. 53; no. 10; pp. 872 - 878
Main Authors: Molina, Yamile, Silva, Abigail, Rauscher, Garth H.
Format: Journal Article
Language:English
Published: United States Lippincott Williams & Wilkins 01-10-2015
Copyright Wolters Kluwer Health, Inc. All rights reserved
Lippincott Williams & Wilkins Ovid Technologies
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Summary:BACKGROUND:Racial/ethnic disparities exist along the breast cancer continuum, including time to a diagnosis. Previous research has largely focused on patient-level factors, and less is known about the role that health care facilities may play in delayed breast cancer care. OBJECTIVES:We examined racial/ethnic disparities in delayed diagnosis for breast cancer in the Breast Cancer Care in Chicago Study and estimated the potential mediating effects of facility factors. RESEARCH DESIGN AND SUBJECTS:Breast cancer patients (N=606) contributed interview and medical record data as part of a population-based study. MEASURES:Race/ethnicity was self-reported at interview. Diagnostic delay was defined as an excess of 60 days between medical presentation and a definitive diagnosis. Facility factors included the facility of medical presentation with respect to(1) accreditation through the National Consortium of Breast Centers; (2) certification as a Breast Imaging Center of Excellence through the American College of Radiology; and (3) status as a disproportionate share hospital through the state of Illinois as well as the number of facilities used between presentation and diagnosis. RESULTS:Relative to non-Hispanic whites, minorities were more likely to experience a diagnostic delay, present at a nonaccredited facility and at a disproportionate share hospital, and involve multiple facilities in their diagnosis. Together, facility factors accounted for 43% of the disparity in diagnostic delay (P<0.0001). CONCLUSIONS:Initial presentation of breast cancer at higher resourced facilities can reduce diagnostic delays. Disparities in delay are partly due to a disproportionate presentation at lower resourced facilities by minorities.
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ISSN:0025-7079
1537-1948
DOI:10.1097/MLR.0000000000000417