Abstract 4128: Disparities in breast cancer relative survival according to payer status: Findings from national cancer data bank
Authors: Shi Runhua , Devarakonda Srinivas S. , Liu Lihong , Burton Gary , Mills Glenn 
Published: May 2015

Abstract
BACKGROUND:
The objective of the current study was to examine the impact of payer status on relative survival outcomes in breast cancer patients.
METHODS:
A population-based analysis of National Cancer Data Bank (NCDB) records for invasive breast cancer was done using data from patients diagnosed between 1998 and 2006 and followed up to 2011. The cohort consisted of breast cancer patients of analytic stage I to stage IV. Information regarding age, race, gender, stage of cancer at diagnosis, year of diagnosis, distance traveled to reach treatment facility, insurance status, income, treatment received and diagnostic facility, and type of treating facility were included in this study. Relative survival ratios were calculated as observed survival divided by expected survival for the entire study population. Age, sex, race, calendar year specific US life table between 1970 and 2007 were used to compute expected survival. Multivariate Poisson modeling was used to estimate relative survival for payer status adjusting for other factors.
RESULTS:
999,277 breast cancer patients who met the inclusion criteria were included in the study. The mean age at diagnosis was 60.1 years. The stage distribution among the variables listed above is statistically significant. The 5-year cumulative relative survivals are 0.72, 0.86, 0.77, 1.42 and 0.91 for uninsured, Medicaid, private insurance, Medicare, and unknown payer status respectively.
In multivariate analysis of relative survival, adjusting for other factors, Adjusted excess hazard ratios (eHR) of death were 1.99, 1.07, 0.90 and 1.38 for uninsured, Medicaid, Medicare, and unknown payer status versus private insurance respectively (P&lt;0.05). The eHRs for blacks and other races versus whites were 1.12 and 1.38 respectively (p&lt;0.05). The eHRs for follow-up year of 2, 3, 4, 5 versus year 1 were 1.15, 0.35, 0.33, and 0.82 respectively (P &lt;0.05). Compared to academic/research program facility type, the eHRs for community cancer program, comprehensive community cancer program, and other specified types of cancer programs were 1.23,1.02 and 25.8 respectively (P &lt;0.05). The eHRs for stage II, III, IV versus stage I were 0.99, 0.90, and 0.89 respectively (P100 miles as compared to those who traveled &lt; 10 miles.
CONCLUSIONS:
Our study showed that payer status affects the relative survival for patients with breast cancer and demonstrated increased mortality for uninsured patients in contrast to survival benefit for patients with Medicare and private insurance.
Citation Format: Runhua Shi, Srinivas S. Devarakonda, Lihong Liu, Gary Burton, Glenn Mills. Disparities in breast cancer relative survival according to payer status: Findings from national cancer data bank. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4128. doi:10.1158/1538-7445.AM2014-4128