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Racial/ethnic differences in patient experiences with health care in association with earlier stage at breast cancer diagnosis: findings from the SEER-CAHPS data

  • Albert J. FariasEmail author
  • Carol Y. Ochoa
  • Gabriela Toledo
  • Soo-In Bang
  • Ann S. Hamilton
  • Xianglin L. Du
Original Paper

Abstract

Background

Black women are more likely to be diagnosed with later stage breast cancer compared to white women due to biological or access to care factors. Therefore, our objective was to identify whether racial/ethnic differences in patient experiences with healthcare are associated with stage at diagnosis.

Methods

We used the SEER registry data linked with patient surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) completed prior to the diagnosis date. We examined responses about various aspects of their care such as the ability to get needed care, and to get care quickly. We used multivariable linear regression to examine racial/ethnic differences in patient experiences, and a multivariable ordinal logistic regression to determine the association between patient experiences and earlier stage at diagnosis.

Results

Of the 10,144 patients, 80.7% were non-Hispanic white, 7.6% black, 7.1% Hispanic, and 4.6% Asian. After controlling for potential confounders, black patients had significantly lower mean scores for getting care quickly (β =  − 2.78), getting needed care (β =  − 2.26), getting needed prescription drugs (β =  − 3.83), and lower ratings of their health care (β =  − 2.33) compared to white patients. More importantly, we found that black patients who reported a 1-unit increase in rating of their experiences with customer service (OR 1.04, 95% CI 1.01–1.06) and the ability to get care quickly (OR 1.03, 1.01–1.05) had higher odds of earlier stage breast cancer.

Conclusion

Racial/ethnic minorities reported poorer patient experiences with care preceding a diagnosis of breast cancer. Better ratings among black patients were associated with earlier stage at diagnosis.

Keywords

Breast cancer Consumer Assessment of Healthcare and Providers (CAHPS) Health care disparities Patient experiences Cancer stage 

Notes

Acknowledgments

The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the National Cancer Institute; the Centers for Medicare & Medicaid Services; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-CAHPS database.

Author contributions

AJF: Conceptualization, methodology, writing- original draft, review, and editing. CO: Conceptualization, writing- original draft, review, and editing. GT: Conceptualization, writing- original draft, review, and editing. SB: Formal analysis, methodology, writing- review and editing. ASH: Conceptualization, methodology, writing- review and editing. XLD: Conceptualization, methodology, writing- review and editing.

Funding

A.J.F was a postdoctoral fellow supported by a University of Texas Health Science Center at Houston School of Public Health Cancer Education and Career Development Program grant from the National Cancer Institute (Grant No. R25-CA57712). This study used the linked SEER-CAHPS database.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interests.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Preventive MedicineKeck School of Medicine of the University of Southern CaliforniaLos AngelesUSA
  2. 2.Gehr Family Center for Health System ScienceKeck School of Medicine of the University of Southern CaliforniaLos AngelesUSA
  3. 3.Department of Pharmaceutical and Health Economics, School of Pharmacy, Leonard Schaeffer Center for Health Policy and EconomicsUniversity of Southern CaliforniaLos AngelesUSA
  4. 4.Department of Epidemiology, Human Genetics and Environmental Science, School of Public HealthUniversity of Texas Health Science Center At HoustonHoustonUSA
  5. 5.Department of Preventive MedicineKeck School of Medicine of the University of Southern CaliforniaLos AngelesUSA

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