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Racial/Ethnic Differences in Receipt of Timely Adjuvant Therapy for Older Women with Breast Cancer: Are Delays Influenced by the Hospitals Where Patients Obtain Surgical Care?

Keywords: Breast cancer;delays;disparities

Objective: To examine whether hospitals where patients obtain care explain racial/ethnic differences in treatment delay.

Data Source: Surveillance, Epidemiology, and End Results data linked with Medicare claims.

Study Design: We examined delays in adjuvant chemotherapy or radiation for women diagnosed with stage I–III breast cancer during 1992–2007. We used multivariable logistic regression to assess the probability of delay by race/ethnicity and included hospital fixed effects to assess whether hospitals explained disparities.

Principal Findings: Among 54,592 women, black (11.9 percent) and Hispanic (9.9 percent) women had more delays than whites (7.8 percent, p < .0001). After adjustment, black (vs. white) women had higher odds of delay (odds ratio = 1.25, 95 percent confidence interval = 1.10–1.42), attenuated somewhat by including hospital fixed effects (OR = 1.17, 95 percent CI = 1.02–1.33).

Conclusions: Hospitals are the important contributors to racial disparities in treatment delay.

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