scholarly journals Evaluating the Effect of Medicaid Expansion on Black/White Breast Cancer Mortality Disparities: A Difference-in-Difference Analysis

2020 ◽  
pp. 1178-1183
Author(s):  
Jason Semprini ◽  
Olufunmilayo Olopade
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
Age Groups ◽  
Mortality Rates ◽  
Cost Of Care ◽  
Medicaid Expansion ◽  
Difference In Difference ◽  
Black And White

PURPOSE Medicaid expansion was designed to increase access to health care. Evidence is mixed, but theory and empirical data suggest that lower cost of care through greater access to insurance increases health care utilization and possibly improves the health of poor and sick populations. However, this major health policy has yet to be thoroughly investigated for its effect on health disparities. The current study is motivated by one of today’s most stark inequalities: the disparity in breast cancer mortality rates between Black and White women. METHODS This analysis used a difference-in-difference fixed effects regression model to evaluate the impact of Medicaid expansion on the disparity between Black and White breast cancer mortality rates. State-level breast cancer mortality data were obtained from the Centers for Disease Control and Prevention. Each state’s Medicaid expansion status was provided by a Kaiser Family Foundation white paper. Two tests were conducted, one compared all expanding states with all nonexpanding states, and the second compared all expanding states with nonexpanding states that voted to expand—but did not by 2014. The difference-in-difference regression models considered the year 2014 a washout period and compared 2012 and 2013 (pretreatment) with 2015 and 2016 (posttreatment). RESULTS Medicaid expansion did not lower the disparity in breast cancer mortality. In contrast to expectations, the Black/White mortality ratio increased in states expanding Medicaid for all Medicaid-eligible age groups, with significant effects in younger age groups ( P = .01 to .15). CONCLUSION These results suggest that states cannot solely rely on access to insurance to alleviate disparities in cancer or other chronic conditions. More exploration of the impacts of low-quality health systems is warranted.

Breast cancer mortality rates trends by race in São Paulo, Brazil

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D B Vale ◽  
B Gozzi ◽  
A C Marcelino ◽  
J F Oliveira ◽  
C Cardoso-Filho ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Mortality ◽  
Access To Health Care ◽  
White Women ◽  
Breast Cancer Mortality ◽  
Age Groups ◽  
Mortality Rates ◽  
Sao Paulo ◽  
São Paulo ◽  
Access To Health

Abstract Background Breast cancer is the main cause of female death by neoplasia in Brazil. Although half of the Brazilian population is black/brown (BB), socio-economic disparities translate in a vulnerable situation to those women. Access to health care is an important barrier to improve the health of BB women. This study aims to investigate trends in breast cancer mortality rates regarding race and age. Methods This is a population-based study of trends evaluation on breast cancer mortality in São Paulo state, Brazil, from 2000 to 2017. The absolute number of deaths and population figures (including race) by age-groups and years were available online from government data. Data on race were not available by ten-year age-groups, so the figures were projected according to the female age structure by year. Total rates by year and race were age-adjusted to the 'World Population (2000)'. For trend analysis, linear regression was used, with 5% level of significance. Results In the period were observed 60,940 breast cancer deaths, 76.7% in white and 17.5% in BB women. The absolute number of deaths in white and BB women was respectively 2,095 and 333 in 2000, and 3,076 and 999 in 2017. The total age-adjusted mortality rates per 100,000 women of white and BB in 2000 were respectively 16.4, 17.2 and 7.5. In 2017 rates were 14.6, 16.6 and 16.1. There was a trend towards reducing the mortality rates of white women (P = 0.002) and in their age-groups from 40 to 79 years (P < 0.03). There was a trend towards increasing the mortality rates of BB women (P < 0.001) and in all their age-groups (P < 0.02). Conclusions Although breast cancer figures of death and mortality rates in BB women have more than doubled in 18 years, rates reached almost the same figures of white women in the period. Changes in behaviour risk factors may explain this result. However, it is very likely that access to health care to these women has been improved, reducing the disparities in the health system. Key messages Breast cancer mortality rates in black/brown women have reached almost the same figures as white women from 2000 to 2017 in São Paulo, Brazil. Access to health care in black women may have improved in São Paulo, Brazil.

scholarly journals Medicare Coverage Improves Mortality Outcomes in Regions of Poverty in United States

2021 ◽  
Vol 2 (9) ◽  
pp. 779-783
Author(s):  
Yana Puckett
Keyword(s):  
Breast Cancer ◽  
Cancer Mortality ◽  
Ductal Carcinoma ◽  
Breast Cancer Mortality ◽  
Age Groups ◽  
Care Facility ◽  
Mortality Rates ◽  
Cancer Death ◽  
Residential Care Facility ◽  
Breast Cancer Death

Objectives: Access to care and poverty have been associated with a higher risk of breast cancer, but their impact on breast cancer death has not been fully evaluated. We hypothesized that analysis of data from a large database would further elucidate the association between socioeconomic status and breast cancer mortality. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify cases of invasive ductal carcinoma diagnosed between 2006-2011, as well as data reflecting the presence or absence of a breast cancer death within five years. Two age groups, 40-64 year old women, and 65+ year old women, were analyzed. From the American Community Survey were acquired annual county level hospital rates, ambulatory care facility rates, nursing/residential care facility rates, rural business rates, population densities, and counts of women in the age groups of interest. Results: With respect to poverty rates, incidence based mortality rates for 40-64 year old women were 13% (99% CI 3%, 25%) higher for counties in the third quartile and 19% (7%, 35%) higher for counties in the fourth quartile (p < 0.01) than for counties in the first quartile; counties in the second quartile did not show higher incidence mortality rates (p > 0.01). Mortality rates for 65+ year old women did not differ among poverty rate quartiles (p > 0.01 for each assessment). A 50% increase in hospitals per 100,000 persons was associated with 8% (5%, 11%) and 5% (1%, 8%) increases in mortality rates for 40-64 y and 65+ y women, respectively, likely reflecting better ascertainment of causes of death at hospitals. Impacts of differences in other rates and population density were not detected (p > 0.01 for each analysis). Conclusion: Counties with higher poverty rates have increased breast cancer mortality rates for 40-64 y women, but not for 65+ y women. Universal coverage associated with Medicare is associated with the absence of an apparent effect of poverty upon breast cancer mortality.

scholarly journals Evaluating the Effect of Medicaid Expansion on Black/White Breast Cancer Mortality Disparities: A Difference-in-Difference Analysis

2019 ◽  
Vol 5 (Supplement_1) ◽  
pp. 10-10
Author(s):  
Jason Semprini ◽  
Olufunmilayo I. Olopade
Keyword(s):  
Breast Cancer ◽  
Health Disparities ◽  
Health Policy ◽  
Cancer Mortality ◽  
Fixed Effects ◽  
Breast Cancer Mortality ◽  
Age Groups ◽  
Average Treatment Effect ◽  
Medicaid Expansion ◽  
The Impact

PURPOSE This analysis used a difference-in-difference (DID) fixed effects regression model to evaluate the impact of Medicaid Expansion on the disparity between black and white breast cancer mortality rates. Medicaid Expansion was designed to increase access to health care. Evidence is mixed, but theory and empirical data suggest that lower cost of care, through greater access to insurance, increases health care utilization and possibly improves the health of poor and sick populations. The goal of Medicaid Expansion was to improve equity. However, this major health policy has yet to be thoroughly investigated for its effect on health disparities. Many widely accepted methods exist to evaluate variations in health policy, but few studies have used such quasi-experimental designs to explore health disparities. The current study is motivated by one of today’s most stark inequalities: the disparity in breast cancer mortality rates between black and white women. To test the impact Medicaid Expansion had on the black/white breast cancer mortality ratio, a DID analysis calculated the policy’s average treatment effect (ATE). METHODS State-level breast cancer mortality data were obtained from the Centers for Disease Control and Prevention. Each state’s Medicaid Expansion status was provided by a Kaiser Family Foundation white paper. Two tests were conducted: one compared all expanding states with all nonexpanding states, and the other compared all expanding states with nonexpanding states that voted to expand (but did not by 2014). Fixed-effects and random-effects regression models were constructed for each specific age group. A Hausman test was calculated to determine which model was most appropriate. The DID regression models considered the year 2014 a wash-out period and compared 2012 and 2013 (pretreatment) to 2015 and 2016 (post-treatment). A graph was presented to test the necessary parallel trend assumption for expanding and nonexpanding states. DID estimators (average treatment effect) and respective P values were reported for each age group. Non–Medicaid-eligible age groups were included as a pseudo-control. RESULTS Medicaid Expansion did not lower the disparity in breast cancer mortality. Converse to expectations, the black/white mortality ratio increased in states expanding Medicaid for all Medicaid-eligible age groups, with significant effects in younger age groups ( P = .01 to .15). CONCLUSION Investigators should use proven quasi-experimental methods to analyze the effect of policy variation on health disparities. Policy makers must consider institutional factors that may limit minority groups from benefiting from macrochanges in health policy. These results suggest that states cannot solely rely on access to insurance to alleviate disparities in cancer or other chronic conditions. More exploration into the impacts of low-quality health systems remain warranted.

Flexible Bayesian P-splines for smoothing age-specific spatio-temporal mortality patterns

2017 ◽  
Vol 28 (2) ◽  
pp. 384-403 ◽  
Author(s):  
T Goicoa ◽  
A Adin ◽  
J Etxeberria ◽  
AF Militino ◽  
MD Ugarte
Keyword(s):  
Breast Cancer ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
Age Groups ◽  
Mortality Rates ◽  
Mcmc Methods ◽  
Mortality Data ◽  
Two Dimensional ◽  
Scale Invariant ◽  
General Decline

In this paper age–space–time models based on one and two-dimensional P-splines with B-spline bases are proposed for smoothing mortality rates, where both fixed relative scale and scale invariant two-dimensional penalties are examined. Model fitting and inference are carried out using integrated nested Laplace approximations, a recent Bayesian technique that speeds up computations compared to McMC methods. The models will be illustrated with Spanish breast cancer mortality data during the period 1985–2010, where a general decline in breast cancer mortality has been observed in Spanish provinces in the last decades. The results reveal that mortality rates for the oldest age groups do not decrease in all provinces.

scholarly journals Breast Cancer Prevalence and Mortality among Hispanic Subgroups in the United States, 2009–2013

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Bijou R. Hunt
Keyword(s):  
Breast Cancer ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
The United States ◽  
Mortality Rates ◽  
Female Breast Cancer ◽  
South American ◽  
Cancer Prevalence ◽  
Targeted Interventions ◽  
Hispanic Subgroup

Background. This paper presents data on breast cancer prevalence and mortality among US Hispanics and Hispanic subgroups, including Cuban, Mexican, Puerto Rican, Central American, and South American.Methods. Five-year average annual female breast cancer prevalence and mortality rates for 2009–2013 were examined using data from the National Health Interview Survey (prevalence) and the National Center for Health Statistics and the American Community Survey (mortality rates).Results. Overall breast cancer prevalence among US Hispanic women was 1.03%. Although the estimates varied slightly by Hispanic subgroup, these differences were not statistically significant. The breast cancer mortality rate for Hispanics overall was 17.71 per 100,000 women. Higher rates were observed among Cubans (17.89), Mexicans (18.78), and Puerto Ricans (19.04), and a lower rate was observed among Central and South Americans (10.15). With the exception of the rate for Cubans, all Hispanic subgroup rates were statistically significantly different from the overall Hispanic rate. Additionally, all Hispanic subgroups rates were statistically significantly higher than the Central and South American rate.Conclusion. The data reveal significant differences in mortality across Hispanic subgroups. These data enable public health officials to develop targeted interventions to help lower breast cancer mortality among the highest risk populations.

scholarly journals Analysis of the Breast Cancer Mortality Rate in Portugal Over a Decade: Spatiotemporal Clustering Analysis

2020 ◽  
Vol 33 (5) ◽  
pp. 305
Author(s):  
Inês Afonso Gomes ◽  
Carla Nunes
Keyword(s):  
Breast Cancer ◽  
Mortality Rate ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
Age Groups ◽  
Female Breast Cancer ◽  
North Coast ◽  
Special Focus ◽  
Female Breast ◽  
Spatiotemporal Clustering

Introduction: Breast cancer is the first cause of cancer-related death in Portuguese women. This study aimed to characterize female breast cancer mortality in Portugal in the period between 2002 and 2013, with a special focus on spatiotemporal patterns.Material and Methods: The breast cancer mortality rate was studied using descriptive analysis (unadjusted and age-adjusted), and spatiotemporal clustering analyses.Results: In 2002 – 2013 the breast cancer mortality rate was 28.47/100 000 inhabitants and the age-adjusted mortality rate was 19.46/100 000 inhabitants. In this period the Lisbon region (urban), Alentejo and Algarve (rural) presented higher breast cancer mortality rate, but Madeira (urban), Lisbon and Algarve had higher age-adjusted mortality rate. In the spatiotemporal analysis, the overall mortality rate showed an increasing trend of 1.218%/year, without spatial variations. Also, different patterns were detected in the < 50, 50 - 64 and ≥ 65 age-groups (+ 0.725%, - 1.781% and + 0.896%, respectively). One temporal (2004 – 2006) and one spatiotemporal cluster (North coast) presented significantly lower mortality rate than expected for the period and/or area (26.2 and 16.1/100 000 inhabitants, respectively). Conversely, two spatiotemporal clusters, located in the city of Lisbon (2002 – 2007) and in the Centre region (2008 – 2013), presented significantly higher breast cancer mortality rate than expected (48.6 and 34.9/100 000 inhabitants, relative risk: 1.74 and 1.26, respectively).Discussion: The annual female crude and adjusted breast cancer mortality rate matched previous publications. However the annual increase detected in the unadjusted rate clashes with the published literature. Overall, the presence of spatiotemporal clusters supports the uneven distribution of the breast cancer mortality reported previously in the different Portuguese regions.Conclusion: This study identified areas and trends of the female breast cancer mortality rate, showing high spatiotemporal variations that must support further detailed studies/interventions.

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