Open AccessChanges in Disparities in Stage of Breast Cancer Diagnosis in Pennsylvania After the Affordable Care Act
Author(s) -
Neal Spada,
Emily Geramita,
Maryam Zamanian,
G J van Londen,
Zhaojun Sun,
Lindsay M. Sabik
Publication year - 2021
Publication title -
journal of women's health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.195
H-Index - 98
eISSN - 1931-843X
pISSN - 1540-9996
DOI - 10.1089/jwh.2020.8478
Subject(s) - medicine , breast cancer , socioeconomic status , logistic regression , demography , odds ratio , residence , cancer , stage (stratigraphy) , cancer registry , ethnic group , health equity , gerontology , population , public health , environmental health , pathology , paleontology , sociology , anthropology , biology
Background: This study sought to determine if increased access to health insurance following the Affordable Care Act (ACA) resulted in an increased proportion of early-stage breast cancer diagnosis among women in Pennsylvania, particularly minorities, rural residents, and those of lower socioeconomic status. Materials and Methods: Data on 35,735 breast cancer cases among women 50-64 and 68-74 years of age in Pennsylvania between 2010 and 2016 were extracted from the Pennsylvania Cancer Registry and analyzed in 2019. Women 50-64 years of age were subdivided by race/ethnicity, area of residence, and socioeconomic status as measured by area deprivation index (ADI). We compared the proportions of early-stage breast cancer diagnosis pre-ACA (2010-2013) and post-ACA (2014-2016) for all women 50-64 years of age to all women 68-74 years of age. This comparison was also made between paired sociodemographic subgroups for women 50-64 years of age. Multivariable logistic regression models were constructed to assess how race, area of residence, ADI, and primary care physician (PCP) density interacted to impact breast cancer diagnosis post-ACA. Results: The proportion of early-stage breast cancer diagnosis increased by 1.71% post-ACA among women 50-64 years of age ( p < 0.01), whereas women 68-74 years of age saw no change. Multivariable logistic regression analysis demonstrated that minority women had lower odds of early-stage breast cancer diagnosis pre-ACA, but not post-ACA, when controlling for ADI. Meanwhile, increased area-level socioeconomic advantage was associated with higher odds of being diagnosed with early-stage breast cancer pre- and post-ACA irrespective of controlling for race, area of residence, or PCP density. Conclusions: Enhanced access to health insurance under the ACA was associated with an increased proportion of early-stage breast cancer diagnosis in Pennsylvanian women 50-64 years of age and may have reduced racial, but not socioeconomic, disparities in breast cancer diagnosis.