Lack of access to chemotherapy for colon cancer: multiplicative disadvantage of being extremely poor, inadequately insured and African American

Details

• Alternative Title:
  BMC Health Serv Res
• Personal Author:
  Gorey, Kevin M ; Haji-Jama, Sundus ; Bartfay, Emma ; Luginaah, Isaac N ; Wright, Frances C ; Kanjeekal, Sindu M
• Description:
  Background
  
  Despite evidence of chemotherapy’s ability to cure or comfort those with colon cancer, nearly half of such Americans do not receive it. African Americans (AA) seem particularly disadvantaged. An ethnicity by poverty by health insurance interaction was hypothesized such that the multiplicative disadvantage of being extremely poor and inadequately insured is worse for AAs than for non-Hispanic white Americans (NHWA).
  
  Methods
  
  California registry data were analyzed for 459 AAs and 3,001 NHWAs diagnosed with stage II to IV colon cancer between 1996 and 2000 and followed until 2011. Socioeconomic data from the 2000 census categorized neighborhoods: extremely poor (≥ 30% of households poor), middle (5-29% poor) and low poverty (< 5% poor). Participants were randomly selected from these poverty strata. Primary health insurers were Medicaid, Medicare, private or none. Chemotherapy rates were age and stage-adjusted and comparisons used standardized rate ratios (RR). Logistic and Cox regressions, respectively, modeled chemotherapy receipt and long term survival.
  
  Results
  
  A significant 3-way ethnicity by poverty by health insurance interaction effect on chemotherapy receipt was observed. Among those who did not live in extremely poor neighborhoods and were adequately insured privately or by Medicare, chemotherapy rates did not differ significantly between AAs (37.7%) and NHWAs (39.5%). Among those who lived in extremely poor neighborhoods and were inadequately insured by Medicaid or uninsured, AAs (14.6%) were nearly 60% less likely to receive chemotherapy than were NHWAs (25.5%, RR = 0.41). When the 3-way interaction effect as well as the main effects of poverty, health insurance and chemotherapy was accounted for, survival rates of AAs and NHWAs were the same.
  
  Conclusions
  
  The multiplicative barrier to colon cancer care that results from being extremely poor and inadequately insured is worse for AAs than it is for NHWAs. AAs are more prevalently poor, inadequately insured, and have fewer assets so they are probably less able to absorb the indirect and direct, but uncovered, costs of colon cancer care. Policy makers ought to be cognizant of these factors as they implement the Affordable Care Act and consider future health care reforms.
  
  
• Subjects:
  Adult Aged Aged, 80 And Over Black Or African American Colonic Neoplasms Female Health Services Accessibility Humans Male Medically Uninsured Middle Aged Neoplasm Staging Poverty Areas Registries Risk Factors Social Class

  More +
• Source:
  BMC Health Serv Res. 2014; 14:133.
• Pubmed ID:
  24655931
• Pubmed Central ID:
  PMC3973249
• Document Type:
  Journal Article
• Funding:
  67161-2/Canadian Institutes of Health Research/Canada ; HHSN261201000034C/PHS HHS/United States ; HHSN261201000035C/PHS HHS/United States ; HHSN261201000140C/PHS HHS/United States ; U58DP003862-01/DP/NCCDPHP CDC HHS/United States
• Place as Subject:
  California ; United States
• Volume:
  14
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:c94da2a96caab5b645d8f27557a74f8ea4707f01f13a4786628c701beee696b3
• Download URL:
  https://stacks.cdc.gov/view/cdc/23111/cdc_23111_DS1.pdf
• File Type:
  [PDF - 211.27 KB ]