Abstract A091: Insurance status and ethnicity/race are associated with late-stage presentation for breast cancer patients
Authors: Balazy Katy E. , Benitez Cecil M. , Jacobson Clare E. , Von Eyben Rie , Horst Kathleen C. 
Published: August 2020

Objective: To determine whether insurance and ethnicity/race are associated with late-stage presentation for breast cancer patients.

Materials/Methods: Patients with breast cancer treated from 2012-2017 were identified (n=1,060). There were 189 patients with stage 0/ductal carcinoma in situ (DCIS), 442 with stage I, 318 with stage II, 74 with stage III, and 38 with stage IV disease. Patients were identified as having either public insurance (Medicare or Medicaid) (n=466) or private insurance (n=594). They were classified into four ethnicity/race categories: Asian, Hispanic, White, and Other. A logistic regression model was run using stage as the outcome to analyze odds ratios for later stage presentation. The model included age, ethnicity/race, insurance, marital status, and language. Two additional interactions improved the fit of the model and were included: age with ethnicity/race, and ethnicity/race with insurance.

Results: There were significant associations between stage and insurance status for Asian and Hispanic patients, and trends for White and Other patients. In general, Asian, White and Other patients with private insurance had lower odds of later-stage disease, while those with public insurance had higher odds of later-stage disease (specifically stages II, III, or IV). Asian patients had significantly lower odds of later-stage presentation if they had private insurance (OR=0.48, 95% CI 0.27-0.88). There was a similar trend for White (OR=0.83) and Other patients (OR=0.49), but not statistically significant. The pattern was opposite for Hispanic patients, who had higher odds of later-stage presentation if they had private insurance instead of public insurance (OR=2.82, 95% CI 1.32-6.11). When compared to other ethnicities/races, Hispanic patients with private insurance had 1.86 times the odds of later-stage disease compared to White patients, 2.55 times the odds compared to Other patients, and 3.03 times the odds compared to Asian patients. On the other hand, Hispanic patients with public insurance fared better than other ethnicities/races. They had 0.55 times the odds of later-stage disease compared to White patients, 0.45 times the odds compared to Other patients, and 0.52 times the odds compared to Asian patients.

Conclusion: There was a significant association between ethnicity/race, insurance, and stage. Asian patients with private insurance demonstrated the lowest odds of late-stage disease, while Hispanic patients with private insurance had highest odds of late-stage disease. For those with public insurance, Hispanic patients had the best odds of early-stage breast cancer compared to Asian, White, and Other patients. The trend toward private insurance being associated with lower-stage disease may be expected for Asian, White, and Other patients; however, the reason why Hispanic patients with private insurance present with later-stage disease remains to be explored.

Citation Format: Katy E. Balazy, Cecil M. Benitez, Clare E. Jacobson, Rie Von Eyben, Kathleen C. Horst. Insurance status and ethnicity/race are associated with late-stage presentation for breast cancer patients [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A091.