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Obinero CG, Pedroza C, Bhadkamkar M, Blakkolb CL, Kao LS, Greives MR. We are moving the needle: Improving racial disparities in immediate breast reconstruction. J Plast Reconstr Aesthet Surg 2024; 88:161-170. [PMID: 37983979 DOI: 10.1016/j.bjps.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Although racial disparities in receipt of immediate breast reconstruction (IBR) have been previously reported, prior studies may not have fully assessed the impact of recent advocacy efforts as healthcare disparities gain increased national attention. The aim of this study is to assess more recent racial differences and annual trends in receiving IBR. METHODS Using the National Surgery Quality Improvement Program database, black or white women over 18 years who underwent mastectomy from 2012 to 2021 were included. IBR was defined by undergoing mastectomy with breast reconstruction during the same anesthetic event. Propensity score analysis was utilized to balance variables between black and white patients. A multivariate logistic regression was performed to determine the effect of race on the odds of receiving IBR. RESULTS The annual percentage of white patients receiving IBR remained stable at around 50% throughout the study period. The annual percentage of black patients receiving IBR increased from 34% in 2012 to 49% in 2021. Compared with white patients, black patients had lower odds of receiving IBR during the entire study period (odds ratio 0.57, 95% confidence interval 0.49-0.67). When assessing annual trends, black patients were less likely to receive IBR each year from 2012 to 2017. By 2021, both races had similar odds of IBR. CONCLUSIONS Although racial disparities in IBR have been longstanding, this study demonstrates that the racial gap appears to be closing. This may be because of increased awareness of racial disparities and their impact on patient outcomes.
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Affiliation(s)
- Chioma G Obinero
- Division of Plastic and Reconstructive Surgery, Department of Surgery, The University of Texas Health Science Center at McGovern Medical School, Houston, TX, USA
| | - Claudia Pedroza
- Center for Clinical Research and Evidence-Based Medicine, The University of Texas Health Science Center at McGovern Medical School, Houston, TX, USA
| | - Mohin Bhadkamkar
- Division of Plastic and Reconstructive Surgery, Department of Surgery, The University of Texas Health Science Center at McGovern Medical School, Houston, TX, USA
| | - Christi L Blakkolb
- Division of Plastic and Reconstructive Surgery, Department of Surgery, The University of Texas Health Science Center at McGovern Medical School, Houston, TX, USA
| | - Lillian S Kao
- Division of Acute Care Surgery, Department of Surgery, The University of Texas Health Science Center at McGovern Medical School, Houston, TX, USA
| | - Matthew R Greives
- Division of Plastic and Reconstructive Surgery, Department of Surgery, The University of Texas Health Science Center at McGovern Medical School, Houston, TX, USA.
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Moten AS, Grande P, Hendrix A, Fleming MD. Early-stage breast cancer treatment disparities in the Midsouth: Has anything changed? Am J Surg 2023; 226:447-454. [PMID: 37438176 DOI: 10.1016/j.amjsurg.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND We sought to determine if racial disparities in treatment and survival persist among patients with breast cancer in the Midsouth. METHODS Patients with early-stage breast cancer were identified in the tumor registry of a large healthcare system in the Midsouth. Regression analyses were performed to determine how race was associated with receipt of treatment and mortality. RESULTS Among 4605 patients, 38.8% were Black. Black patients were less likely to undergo surgery (OR = 0.71; 95%CI 0.53-0.97) and receive hormone therapy (OR = 0.81; 95%CI 0.69-0.95) than White patients, but more likely to receive radiation (OR = 1.20; 95%CI 1.08-1.40) and chemotherapy (OR = 1.36; 95%CI 1.16-1.61). Among Black patients, the risk of mortality was lower among those who underwent partial (OR = 0.25; 95%CI 0.12-0.51) or total (OR = 0.35; 95%CI 0.16-0.76) mastectomy and among those who received hormone therapy (OR = 0.62; 95%CI 0.40-0.97). CONCLUSION There remains room for improvement in providing treatments that optimize survival among this patient population.
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Affiliation(s)
- Ambria S Moten
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Payton Grande
- The University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
| | - Ashley Hendrix
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Martin D Fleming
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA.
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3
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Yuan R, Zhang C, Li Q, Ji M, He N. The impact of marital status on stage at diagnosis and survival of female patients with breast and gynecologic cancers: A meta-analysis. Gynecol Oncol 2021; 162:778-787. [PMID: 34140180 DOI: 10.1016/j.ygyno.2021.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/08/2021] [Indexed: 12/24/2022]
Abstract
The aim of this meta-analysis is to evaluate the effect of marital status on the stage at diagnosis and survival of female patients with breast and gynecologic cancers. A systematic literature search was conducted on electronic databases (PubMed, Cochrane and EMBASE) till December 31, 2020. Publications investigating the association of marital status with stage at diagnosis and/or cancer-specific mortality (CSM) and/or overall survival (OS) in female patients with breast or gynecologic cancers were retrieved. After studies were selected according to inclusion criteria, data extraction, quality assessment and data analysis were performed. 55 articles were eligible for inclusion, consisting of 1,195,773 female cancer patients with breast, vulvar, cervical, endometrial and ovarian cancers. Unmarried female cancer patients had higher odds of being diagnosed at later stage [odds ratio (OR) = 1.28, 95% confidence interval (CI): 1.22-1.36)] and worse survival outcomes in CSM [hazard ratio (HR) = 1.22, 95% CI: 1.16-1.28] and OS (HR = 1.20, 95% CI: 1.14-1.25). This estimate did not vary by level of social support, number of adjustment factors, or between America and Europe. Being married is associated with timely diagnosis and favorable prognosis in most women's cancers. Unmarried female cancer patients have a higher risk of late-stage diagnosis and worse survival outcomes than the married. Greater concern shall be demonstrated towards unmarried female cancer patients. Furthermore, the impact of lacking economic and emotional support on survival outcomes in unmarried female cancer patients deserves particular attention.
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Affiliation(s)
- Ruixia Yuan
- Clinical Big Data Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chao Zhang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Qi Li
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mei Ji
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Nannan He
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Johannesen K, Janzon M, Jernberg T, Henriksson M. Subcategorizing the Expected Value of Perfect Implementation to Identify When and Where to Invest in Implementation Initiatives. Med Decis Making 2020; 40:327-338. [PMID: 32133911 PMCID: PMC7488812 DOI: 10.1177/0272989x20907353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 01/23/2020] [Indexed: 01/22/2023]
Abstract
Purpose. Clinical practice variations and low implementation of effective and cost-effective health care technologies are a key challenge for health care systems and may lead to suboptimal treatment and health loss for patients. The purpose of this work was to subcategorize the expected value of perfect implementation (EVPIM) to enable estimation of the absolute and relative value of eliminating slow, low, and delayed implementation. Methods. Building on the EVPIM framework, this work defines EVPIM subcategories to estimate the expected value of eliminating slow, low, or delayed implementation. The work also shows how information on regional implementation patterns can be used to estimate the value of eliminating regional implementation variation. The application of this subcategorization is illustrated by a case study of the implementation of an antiplatelet therapy for the secondary prevention after myocardial infarction in Sweden. Incremental net benefit (INB) estimates are based on published cost-effectiveness assessments and a threshold of SEK 250,000 (£22,300) per quality-adjusted life year (QALY). Results. In the case study, slow, low, and delayed implementation was estimated to represent 22%, 34%, and 44% of the total population EVPIM (2941 QALYs or SEK 735 million), respectively. The value of eliminating implementation variation across health care regions was estimated to 39% of total EVPIM (1138 QALYs). Conclusion. Subcategorizing EVPIM estimates the absolute and relative value of eliminating different parts of suboptimal implementation. By doing so, this approach could help decision makers to identify which parts of suboptimal implementation are contributing most to total EVPIM and provide the basis for assessing the cost and benefit of implementation activities that may address these in future implementation of health care interventions.
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Affiliation(s)
- Kasper Johannesen
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Magnus Janzon
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm, Sweden
| | - Martin Henriksson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Haidar OM, Lamarche PA, Levesque JF, Pampalon R. The Influence of Individuals' Vulnerabilities and Their Interactions on the Assessment of a Primary Care Experience. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2018; 48:798-819. [PMID: 29807483 DOI: 10.1177/0020731418768186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examines the relationship between the vulnerabilities of individuals and their assessments of their primary care experiences in the setting of a universal care system. It focuses on 2 specific objectives: (1) evaluating the influence of each of the 5 vulnerabilities on the assessment of the care experience; (2) evaluating the influence of the interactions between the different types of vulnerabilities on the assessment of the care experience. The study identifies the primary care experience of 9,206 people. The health-related, biological, material, relational, and cultural vulnerabilities are also evaluated. Generally, individuals' vulnerabilities are associated with a positive assessment of the primary care experience except for the cultural vulnerability. Material vulnerability is most frequently associated with a positive assessment of the primary care experience. The interactions between the multiple vulnerabilities present for one individual often modify the effect of vulnerability on the assessment of the experience of care. The positive effect of a vulnerability on the assessment of the care experience often increases in the presence of a second vulnerability, especially the health-related vulnerability. The simultaneous presence of health-related vulnerability cancels the negative influence of cultural vulnerability on the assessment of the primary care experience.
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Affiliation(s)
- Ola M Haidar
- 1 University of Montreal, School of Public Health, Montreal, Canada
| | - Paul A Lamarche
- 2 University of Montreal, School of Public Health, Montreal, Canada
| | - Jean-Frederic Levesque
- 3 Bureau of Health Information and Center for Primary Health Care and Equity, University of New South Wales, New South Wales, Australia
| | - Robert Pampalon
- 4 National Institute of Public Health of Quebec and Department of Social and Preventive Medicine, University of Laval, Quebec, Canada
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Prieto D, Soto-Ferrari M, Tija R, Peña L, Burke L, Miller L, Berndt K, Hill B, Haghsenas J, Maltz E, White E, Atwood M, Norman E. Literature review of data-based models for identification of factors associated with racial disparities in breast cancer mortality. Health Syst (Basingstoke) 2018; 8:75-98. [PMID: 31275571 DOI: 10.1080/20476965.2018.1440925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 01/29/2018] [Accepted: 02/08/2018] [Indexed: 01/03/2023] Open
Abstract
In the United States, early detection methods have contributed to the reduction of overall breast cancer mortality but this pattern has not been observed uniformly across all racial groups. A vast body of research literature shows a set of health care, socio-economic, biological, physical, and behavioural factors influencing the mortality disparity. In this paper, we review the modelling frameworks, statistical tests, and databases used in understanding influential factors, and we discuss the factors documented in the modelling literature. Our findings suggest that disparities research relies on conventional modelling and statistical tools for quantitative analysis, and there exist opportunities to implement data-based modelling frameworks for (1) exploring mechanisms triggering disparities, (2) increasing the collection of behavioural data, and (3) monitoring factors associated with the mortality disparity across time.
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Affiliation(s)
- Diana Prieto
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA.,Johns Hopkins Carey Business School, Baltimore, MD, USA
| | - Milton Soto-Ferrari
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA.,Department of Marketing and Operations, Scott College of Business, Terre Haute, IN, USA
| | - Rindy Tija
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
| | - Lorena Peña
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
| | - Leandra Burke
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Lisa Miller
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Kelsey Berndt
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Brian Hill
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Jafar Haghsenas
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Ethan Maltz
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Evan White
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Maggie Atwood
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Earl Norman
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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Armamento-Villareal R, Shah VO, Aguirre LE, Meisner ALW, Qualls C, Royce ME. The rs4646 and rs12592697 Polymorphisms in CYP19A1 Are Associated with Disease Progression among Patients with Breast Cancer from Different Racial/Ethnic Backgrounds. Front Genet 2016; 7:211. [PMID: 27994616 PMCID: PMC5133243 DOI: 10.3389/fgene.2016.00211] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 11/18/2016] [Indexed: 12/26/2022] Open
Abstract
Given the racial/ethnic disparities in breast cancer, we evaluated the association between CYP19A1 single nucleotide polymorphisms (SNPs) on disease progression in women with breast cancer from different racial/ethnic backgrounds. This is a cross-sectional analysis of data from 327 women with breast cancer in the Expanded Breast Cancer Registry program of the University of New Mexico. Stored DNA samples were analyzed for CYP19A1 SNPs using a custom designed microarray panel. Genotype-phenotype correlations were analyzed. Of the 384 SNPs, 2 were associated with clinically significant outcomes, the rs4646 and rs12592697. The T allele for the rs4646 was associated with advanced stage of the disease at the time of presentation (odds ratio [OR]:1.8, confidence intervals [CI]: 1.05–3.13, p < 0.05) and a more progressive disease (OR: 2.1 [CI: 1.1–4.0], p = 0.04). For the rs12592697, the variant T allele was more frequent in Hispanic women and associated with a more progressive disease (OR: 2.05 [CI: 1.0–4.0], p = 0.04). However, further analysis according to menopausal status showed that the association between these 2 SNPs with disease progression or the stage at diagnosis are confined only to postmenopausal women. The odds ratios of disease progression among postmenopausal women carrying the T allele for the rs4646 and rs12592697 are 3.05 (1.21, 7.74, p = 0.02) and 3.80 (1.24, 11.6, p = 0.02), respectively. Regardless, differences in disease progression among the different genotypes for both SNPs disappeared after adjustment for treatment. In summary, the rs4646 and the rs12592697 SNPs in CYP19A1 are associated with differences in disease progression in postmenopausal women. However, treatment appears to mitigate the differences in genetic risk.
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Affiliation(s)
- Reina Armamento-Villareal
- Department of Internal Medicine, Baylor College of MedicineHouston, TX, USA; Department of Internal Medicine, Michael E. DeBakey VA Medical CenterHouston, TX, USA
| | - Vallabh O Shah
- Department of Biochemistry and Molecular Biology, University of New Mexico Health Science CenterAlbuquerque, NM, USA; New Mexico Tumor Registry, University of New Mexico Health Sciences CenterAlbuquerque, NM, USA
| | - Lina E Aguirre
- Department of Internal Medicine, New Mexico VA Health Care System Albuquerque, NM, USA
| | - Angela L W Meisner
- New Mexico Tumor Registry, University of New Mexico Health Sciences Center Albuquerque, NM, USA
| | - Clifford Qualls
- Department of Mathematics, University of New Mexico Health Science Center Albuquerque, NM, USA
| | - Melanie E Royce
- New Mexico Tumor Registry, University of New Mexico Health Sciences Center Albuquerque, NM, USA
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Abstract
Breast cancer is the second deadliest cancer for women in the demographically unique mountainous west state of Nevada. This study aims to accurately characterize breast cancer survival among the diverse women of the flourishing Silver State. Nevada Central Cancer Registry data was linked with the National Death Index and the Social Security Administration Masterfile. Overall 5-year age-adjusted cause-specific survival, survival stratified by race/ethnicity, and stage-specific survival stratified by region of Nevada were calculated. Adjusted hazard ratios were computed with Cox proportional hazards regression. 11,111 cases of breast cancer were diagnosed from 2003 to 2010. Overall 5-year breast cancer survival in Nevada was 84.4 %, significantly lower than the US, at 89.2 %. Black and Filipina women had a higher risk of death than white women. Poor survival in the racially and ethnically diverse Las Vegas metropolitan area, with a large foreign-born population, drives Nevada's low overall survival. System-wide changes are recommended to reduce the racial/ethnic disparities seen for black and Filipina women and improve outcomes for all.
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9
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Faria R, Walker S, Whyte S, Dixon S, Palmer S, Sculpher M. How to Invest in Getting Cost-effective Technologies into Practice? A Framework for Value of Implementation Analysis Applied to Novel Oral Anticoagulants. Med Decis Making 2016; 37:148-161. [DOI: 10.1177/0272989x16645577] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cost-effective interventions are often implemented slowly and suboptimally in clinical practice. In such situations, a range of implementation activities may be considered to increase uptake. A framework is proposed to use cost-effectiveness analysis to inform decisions on how best to invest in implementation activities. This framework addresses 2 key issues: 1) how to account for changes in utilization in the future in the absence of implementation activities; and 2) how to prioritize implementation efforts between subgroups. A case study demonstrates the framework’s application: novel oral anticoagulants (NOACs) for the prevention of stroke in the National Health Service in England and Wales. The results suggest that there is value in additional implementation activities to improve uptake of NOACs, particularly in targeting patients with average or poor warfarin control. At a cost-effectiveness threshold of £20,000 per quality-adjusted life-year (QALY) gained, additional investment in an educational activity that increases the utilization of NOACs by 5% in all patients currently taking warfarin generates an additional 254 QALYs, compared with 973 QALYs in the subgroup with average to poor warfarin control. However, greater value could be achieved with higher uptake of anticoagulation more generally: switching 5% of patients who are potentially eligible for anticoagulation but are currently receiving no treatment or are using aspirin would generate an additional 4990 QALYs. This work can help health services make decisions on investment at different points of the care pathway or across disease areas in a manner consistent with the value assessment of new interventions.
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Affiliation(s)
- Rita Faria
- Centre for Health Economics, University of York, York, UK (RF, SWa, SP, MS)
- School of Health and Related Research, University of Sheffield, Sheffield, UK (SWh, SD)
| | - Simon Walker
- Centre for Health Economics, University of York, York, UK (RF, SWa, SP, MS)
- School of Health and Related Research, University of Sheffield, Sheffield, UK (SWh, SD)
| | - Sophie Whyte
- Centre for Health Economics, University of York, York, UK (RF, SWa, SP, MS)
- School of Health and Related Research, University of Sheffield, Sheffield, UK (SWh, SD)
| | - Simon Dixon
- Centre for Health Economics, University of York, York, UK (RF, SWa, SP, MS)
- School of Health and Related Research, University of Sheffield, Sheffield, UK (SWh, SD)
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK (RF, SWa, SP, MS)
- School of Health and Related Research, University of Sheffield, Sheffield, UK (SWh, SD)
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK (RF, SWa, SP, MS)
- School of Health and Related Research, University of Sheffield, Sheffield, UK (SWh, SD)
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10
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Whyte S, Dixon S, Faria R, Walker S, Palmer S, Sculpher M, Radford S. Estimating the Cost-Effectiveness of Implementation: Is Sufficient Evidence Available? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:138-44. [PMID: 27021746 PMCID: PMC4823278 DOI: 10.1016/j.jval.2015.12.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 12/07/2015] [Accepted: 12/11/2015] [Indexed: 05/14/2023]
Abstract
BACKGROUND Timely implementation of recommended interventions can provide health benefits to patients and cost savings to the health service provider. Effective approaches to increase the implementation of guidance are needed. Since investment in activities that improve implementation competes for funding against other health generating interventions, it should be assessed in term of its costs and benefits. OBJECTIVE In 2010, the National Institute for Health and Care Excellence released a clinical guideline recommending natriuretic peptide (NP) testing in patients with suspected heart failure. However, its implementation in practice was variable across the National Health Service in England. This study demonstrates the use of multi-period analysis together with diffusion curves to estimate the value of investing in implementation activities to increase uptake of NP testing. METHODS Diffusion curves were estimated based on historic data to produce predictions of future utilization. The value of an implementation activity (given its expected costs and effectiveness) was estimated. Both a static population and a multi-period analysis were undertaken. RESULTS The value of implementation interventions encouraging the utilization of NP testing is shown to decrease over time as natural diffusion occurs. Sensitivity analyses indicated that the value of the implementation activity depends on its efficacy and on the population size. CONCLUSIONS Value of implementation can help inform policy decisions of how to invest in implementation activities even in situations in which data are sparse. Multi-period analysis is essential to accurately quantify the time profile of the value of implementation given the natural diffusion of the intervention and the incidence of the disease.
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Affiliation(s)
- Sophie Whyte
- The School of Health and Related Research, University of Sheffield, Sheffield, UK.
| | - Simon Dixon
- The School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rita Faria
- Centre for Health Economics, University of York, York, UK
| | - Simon Walker
- Centre for Health Economics, University of York, York, UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
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11
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Canin B, Freund KM, Ganz PA, Hershman DL, Paskett ED. Disparities in breast cancer care and research: report from a Breast Cancer Research Foundation sponsored workshop, 9-10 October 2014. NPJ Breast Cancer 2015; 1:15013. [PMID: 28721369 PMCID: PMC5515204 DOI: 10.1038/npjbcancer.2015.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 09/07/2015] [Indexed: 11/08/2022] Open
Abstract
The purpose of this workshop was to bring together diverse stakeholders from the breast cancer research community to discuss critical issues related to disparities in breast cancer care and to identify potential strategies for reducing disparities and inequities in care through research. The workshop format included a series of formal content presentations, participation in break out groups that focused on specific topics highlighted in the content presentations, reporting back of findings and a facilitated discussion that focused on shaping a research agenda. The workshop members concluded that numerous groups of women are at increased risk for disparities in breast cancer care: many patients and survivors suffer disproportionately from inadequate access to high-quality diagnosis and treatment, resulting in more frequent and severe adverse outcomes from the disease. Research on breast cancer disparities provides a major opportunity for reducing the burden of breast cancer. Thus, it is important for the Breast Cancer Research Foundation and other research funders to consider how to best promote research focused on ensuring breast cancer health equity.
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Affiliation(s)
| | - Karen M Freund
- Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Patricia A Ganz
- UCLA Schools of Medicine and Public Health, Los Angeles, CA, USA
- Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
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12
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Sineshaw HM, Freedman RA, Ward EM, Flanders WD, Jemal A. Black/White Disparities in Receipt of Treatment and Survival Among Men With Early-Stage Breast Cancer. J Clin Oncol 2015; 33:2337-44. [PMID: 25940726 DOI: 10.1200/jco.2014.60.5584] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To examine the extent of black/white disparities in receipt of treatment and survival for early-stage breast cancer in men age 18 to 64 and ≥ 65 years. PATIENTS AND METHODS We identified 725 non-Hispanic black (black) and 5,247 non-Hispanic white (white) men diagnosed with early-stage breast cancer from 2004 to 2011 in the National Cancer Data Base. We used multivariable logistic regression and calculated standardized risk ratios to predict receipt of treatment and a proportional hazards model to estimate overall hazard ratios (HRs) in black versus white men age 18 to 64 and ≥ 65 years, separately. RESULTS Receipt of treatment was remarkably similar between blacks and whites in both age groups. Black and white older men had lower receipt of chemotherapy (39.2% and 42.0%, respectively) compared with younger patients (76.7% and 79.3%, respectively). Younger black men had a 76% higher risk of death than younger white men after adjustment for clinical factors only (HR, 1.76; 95% CI, 1.11 to 2.78), but this difference significantly diminished after subsequent adjustment for insurance and income (HR, 1.37; 95% CI, 0.83 to 2.24). In those age ≥ 65 years, the excess risk of death in blacks versus whites was nonsignificant and not affected by adjustment for covariates. CONCLUSION The excess risk of death in black versus white men diagnosed with early-stage breast cancer was largely confined to those age 18 to 64 years and became nonsignificant after adjustment for differences in insurance and income. These findings suggest the importance of improving access to care in reducing racial disparities in male breast cancer mortality.
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Affiliation(s)
- Helmneh M Sineshaw
- Helmneh M. Sineshaw, Elizabeth M. Ward, W. Dana Flanders, and Ahmedin Jemal, American Cancer Society; W. Dana Flanders, Rollins School of Public Health, Emory University, Atlanta, GA; and Rachel A. Freedman, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA.
| | - Rachel A Freedman
- Helmneh M. Sineshaw, Elizabeth M. Ward, W. Dana Flanders, and Ahmedin Jemal, American Cancer Society; W. Dana Flanders, Rollins School of Public Health, Emory University, Atlanta, GA; and Rachel A. Freedman, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA
| | - Elizabeth M Ward
- Helmneh M. Sineshaw, Elizabeth M. Ward, W. Dana Flanders, and Ahmedin Jemal, American Cancer Society; W. Dana Flanders, Rollins School of Public Health, Emory University, Atlanta, GA; and Rachel A. Freedman, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA
| | - W Dana Flanders
- Helmneh M. Sineshaw, Elizabeth M. Ward, W. Dana Flanders, and Ahmedin Jemal, American Cancer Society; W. Dana Flanders, Rollins School of Public Health, Emory University, Atlanta, GA; and Rachel A. Freedman, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA
| | - Ahmedin Jemal
- Helmneh M. Sineshaw, Elizabeth M. Ward, W. Dana Flanders, and Ahmedin Jemal, American Cancer Society; W. Dana Flanders, Rollins School of Public Health, Emory University, Atlanta, GA; and Rachel A. Freedman, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA
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Hoomans T, Severens JL. Economic evaluation of implementation strategies in health care. Implement Sci 2014; 9:168. [PMID: 25518730 PMCID: PMC4279808 DOI: 10.1186/s13012-014-0168-y] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 09/18/2014] [Indexed: 11/10/2022] Open
Abstract
Economic evaluations can inform decisions about the efficiency and allocation of resources to implementation strategies—strategies explicitly designed to inform care providers and patients about the best available research evidence and to enhance its use in their practices. These strategies are increasingly popular in health care, especially in light of growing concerns about quality of care and limits on resources. But such concerns have hardly motivated health authorities and other decision-makers to spend on some form of economic evaluation in their assessments of implementation strategies. This editorial addresses the importance of economic evaluation in the context of implementation science—particularly, how these analyses can be most efficiently incorporated into decision-making processes about implementation strategies.
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Affiliation(s)
- Ties Hoomans
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands. .,Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, USA.
| | - Johan L Severens
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands. .,Institute of Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands.
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Abstract
PURPOSE/OBJECTIVES To identify antecedents and consequences of social disconnection in African American women diagnosed with breast cancer as described in the extant literature. DATA SOURCES Literature review using broad exploration of a personal database and informal exploration of databases such as MEDLINE®, as well as clinical experience. DATA SYNTHESIS A formal definition, antecedents, and consequences of social disconnection were drawn from a review of the literature. CONCLUSIONS Antecedents included personal responses to a breast cancer diagnosis and cultural influences. Consequences included decreased well-being, partner abandonment, and decreased health. IMPLICATIONS FOR NURSING Areas for future research include using measurement tools for assessment, as well as creating categories for the trajectory of social disconnection and determining its severity and nature. Nurses should be alert to the possibility of social disconnection in patients with cancer. Nurses can assist the patient in talking to his or her family and friends about the cancer diagnosis and treatment.
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Affiliation(s)
- Sue P Heiney
- College of Nursing, University of South Carolina in Columbia
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Elo IT, Beltrán-Sánchez H, Macinko J. The Contribution of Health Care and Other Interventions to Black-White Disparities in Life Expectancy, 1980-2007. POPULATION RESEARCH AND POLICY REVIEW 2014; 33:97-126. [PMID: 24554793 PMCID: PMC3925638 DOI: 10.1007/s11113-013-9309-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Black-white mortality disparities remain sizable in the United States. In this study, we use the concept of avoidable/amenable mortality to estimate cause-of-death contributions to the difference in life expectancy between whites and blacks by gender in the United States in 1980, 1993, and 2007. We begin with a review of the concept of "avoidable mortality" and results of prior studies using this cause-of-death classification. We then present the results of our empirical analyses. We classified causes of death as amenable to medical care, sensitive to public health policies and health behaviors, ischemic heart disease, suicide, HIV/AIDS, and all other causes combined. We used vital statistics data on deaths and Census Bureau population estimates and standard demographic decomposition techniques. In 2007, causes of death amenable to medical care continued to account for close to 2 years of the racial difference in life expectancy among men (2.08) and women (1.85). Causes amenable to public health interventions made a larger contribution to the racial difference in life expectancy among men (1.17 years) than women (0.08 years). The contribution of HIV/AIDS substantially widened the racial difference among both men (1.08 years) and women (0.42 years) in 1993, but its contribution declined over time. Despite progress observed over the time period studied, a substantial portion of black-white disparities in mortality could be reduced given more equitable access to medical care and health interventions.
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Affiliation(s)
- Irma T. Elo
- Population Studies Center, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104, USA
| | - Hiram Beltrán-Sánchez
- Center for Demography and Ecology, University of Wisconsin, 4329 Sewell Social Science, Madison, WI, USA
| | - James Macinko
- New York University, 411 Lafayette Street 5th Floor, New York, NY 10003, USA
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McGee SA, Durham DD, Tse CK, Millikan RC. Determinants of breast cancer treatment delay differ for African American and White women. Cancer Epidemiol Biomarkers Prev 2013; 22:1227-38. [PMID: 23825306 DOI: 10.1158/1055-9965.epi-12-1432] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Timeliness of care may contribute to racial disparities in breast cancer mortality. African American women experience greater treatment delay than White women in most, but not all studies. Understanding these disparities is challenging as many studies lack patient-reported data and use administrative data sources that collect limited types of information. We used interview and medical record data from the Carolina Breast Cancer Study (CBCS) to identify determinants of delay and assess whether disparities exist between White and African American women (n = 601). METHODS The CBCS is a population-based study of North Carolina women. We investigated the association of demographic and socioeconomic characteristics, healthcare access, clinical factors, and measures of emotional and functional well-being with treatment delay. The association of race and selected characteristics with delays of more than 30 days was assessed using logistic regression. RESULTS Household size, losing a job due to one's diagnosis, and immediate reconstruction were associated with delay in the overall population and among White women. Immediate reconstruction and treatment type were associated with delay among African American women. Racial disparities in treatment delay were not evident in the overall population. In the adjusted models, African American women experienced greater delay than White women for younger age groups: OR, 3.34; 95% confidence interval (CI), 1.07-10.38 for ages 20 to 39 years, and OR, 3.40; 95% CI, 1.76-6.54 for ages 40 to 49 years. CONCLUSIONS Determinants of treatment delay vary by race. Racial disparities in treatment delay exist among women younger than 50 years. IMPACT Specific populations need to be targeted when identifying and addressing determinants of treatment delay.
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Affiliation(s)
- Sasha A McGee
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Derouen MC, Gomez SL, Press DJ, Tao L, Kurian AW, Keegan THM. A Population-Based Observational Study of First-Course Treatment and Survival for Adolescent and Young Adult Females with Breast Cancer. J Adolesc Young Adult Oncol 2013; 2:95-103. [PMID: 24066271 DOI: 10.1089/jayao.2013.0004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Young age at breast cancer diagnosis is associated with poor survival. However, little is known about factors associated with first-course treatment receipt or survival among adolescent and young adult (AYA) females aged 15-39 years. METHODS Data regarding 19,906 eligible AYA breast cancers diagnosed in California during 1992-2009 were obtained from the population-based California Cancer Registry. Multivariable logistic regression was used to evaluate clinical and sociodemographic differences in treatment receipt. Multivariable Cox proportional hazards regression was used to examine differences in survival by initial treatment, and by patient and tumor characteristics. RESULTS Black and Hispanic AYAs diagnosed with in situ or stages I-III breast cancer were more likely than White AYAs to receive breast-conserving surgery (BCS) without radiation; Asian and Hispanic AYAs were more likely than Whites to receive mastectomy. Women in lower socioeconomic status (SES) neighborhoods were more likely to omit radiation after BCS, more likely to receive mastectomy, and less likely to receive chemotherapy, compared to those in higher SES neighborhoods. Among patients with invasive disease, survival improved an average of 5% per year during 1992-2009. AYAs who received BCS with radiation experienced better survival than other surgery/radiation options. Black AYAs had poorer survival than Whites. AYAs who resided in higher SES neighborhoods had better survival. CONCLUSIONS Treatment receipt among AYAs with breast cancer varied by race/ethnicity and neighborhood SES. Poor survival for Black AYAs and AYAs living in low SES neighborhoods in models adjusted for treatment receipt suggests that factors other than treatment may also be important to disease outcome.
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Affiliation(s)
- Mindy C Derouen
- Cancer Prevention Institute of California , Fremont, California
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Comparison of clinicopathologic features and survival in young American women aged 18-39 years in different ethnic groups with breast cancer. Br J Cancer 2013; 109:1302-9. [PMID: 23907433 PMCID: PMC3778276 DOI: 10.1038/bjc.2013.387] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/18/2013] [Accepted: 06/24/2013] [Indexed: 12/03/2022] Open
Abstract
Background: Ethnic disparities in breast cancer diagnoses and disease-specific survival (DSS) rates in the United States are well known. However, few studies have assessed differences specifically between Asians American(s) and other ethnic groups, particularly among Asian American(s) subgroups, in women aged 18–39 years. Methods: The Surveillance, Epidemiology, and End Results database was used to identify women aged 18–39 years diagnosed with breast cancer from 1973 to 2009. Incidence rates, clinicopathologic features, and survival among broad ethnic groups and among Asian subgroups. Results: A total of 55 153 breast cancer women aged 18–39 years were identified: 63.6% non-Hispanic white (NHW), 14.9% black, 12.8% Hispanic-white (HW), and 8.7% Asian. The overall incidence rates were stable from 1992 to 2009. Asian patients had the least advanced disease at presentation and the lowest risk of death compared with the other groups. All the Asian subgroups except the Hawaiian/Pacific Islander subgroup had better DSS than NHW, black, and HW patients. Advanced tumour stage was associated with poorer DSS in all the ethnic groups. High tumour grade was associated with poorer DSS in the NHW, black, HW, and Chinese groups. Younger age at diagnosis was associated with poorer DSS in the NHW and black groups. Conclusion: The presenting clinical and pathologic features of breast cancer differ by ethnicity in the United States, and these differences impact survival in women younger than 40 years.
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Dinan MA, Curtis LH, Carpenter WR, Biddle AK, Abernethy AP, Patz EF, Schulman KA, Weinberger M. Variations in use of PET among Medicare beneficiaries with non-small cell lung cancer, 1998-2007. Radiology 2013; 267:807-17. [PMID: 23418003 DOI: 10.1148/radiol.12120174] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To explore demographic and regional factors associated with the use of positron emission tomography (PET) in patients with non-small cell lung cancer (NSCLC) and to determine whether their associations with PET use has changed over time. MATERIALS AND METHODS The Office of Human Research Ethics at the University of North Carolina and the institutional review board of the Duke University Health System approved (with waiver of informed consent) this retrospective analysis of Surveillance Epidemiology and End Results Medicare data for Medicare beneficiaries given a diagnosis of NSCLC between 1998 and 2007. The primary outcome was change in the number of PET examinations 2 months before to 4 months after diagnosis, examined according to year and sociodemographic subgroup. PET use was compared between demographic and geographic subgroups and between early (1998-2000) and late (2005-2007) cohorts by using χ(2) tests. Factors associated with use of PET during the study period were further examined by using logit and linear probability multivariable regression analyses. RESULTS The final cohort included 46 544 patients with 46 935 cases of NSCLC. By 2005, more than half of patients underwent one or more PET examinations, regardless of demographic subgroup. In multivariable logistic regression analysis, patients who underwent PET were more likely to be married, nonblack, and younger than 80 years and to live in census tracts with higher education levels or in the Northeast (P < .001 for all). Living within 40 miles of a PET facility was initially associated with undergoing PET (P < .001), but this association disappeared by 2007. Imaging rates increased more rapidly in patients who were nonblack (P ≤ .01), patients who were younger than 81 years (P < .001), and patients who lived in the Northeast and South (P < .001). CONCLUSION PET imaging among Medicare beneficiaries with NSCLC was initially concentrated among nonblack patients younger than 81 years. Despite widespread adoption among all subgroups, differences within demographic subgroups remained.
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Affiliation(s)
- Michaela A Dinan
- Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715, USA
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Hyslop T, Michael Y, Avery T, Rui H. Population and target considerations for triple-negative breast cancer clinical trials. Biomark Med 2013; 7:11-21. [PMID: 23387481 PMCID: PMC3677035 DOI: 10.2217/bmm.12.114] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Triple-negative breast cancer (TNBC) is an aggressive disease subtype that has a poor prognosis. Extensive epidemiological evidence demonstrates clear socioeconomic and demographic associations with increased likelihood of TNBC in both poorer and minority populations. Thus, biological aggressiveness with few known therapeutic directions generates disparities in breast cancer outcomes for vulnerable populations. Emerging molecular evidence of potential targets in triple-negative subpopulations offers great potential for future clinical trial directions. However, trials must appropriately consider populations at risk for aggressive subtypes of disease in order to address this disparity most completely. New US FDA draft guidance documents provide both flexible outcomes for accelerated approvals as well as flexibility in design with adaptive trials. Careful planning with design, potential patient population and choices of molecular targets informed by biomarkers will be critical to address TNBC clinical care.
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Affiliation(s)
- Terry Hyslop
- Department of Pharmacology & Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Kimmel Cancer Center, Philadelphia, PA, USA.
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21
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Kim JM, Jo YS, Park EC, Cho WH, Choi J, Chang HS. The Relationship Between Economic Status and Mortality of South Koreans, as It Relates to Average Life Expectancy. Asia Pac J Public Health 2012. [DOI: 10.1177/1010539512466569] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study investigates the relationship between economic status and mortality of Korean men and women who were under and over the average national life expectancy using Cox’s proportional hazard model to adjust for health status, past medical history, and age. The study subjects come from local applicants of Korean National Health Insurance who had a health examination in 2005. They were enrolled into a follow-up investigation from 2005 to 2011. In individuals younger than the average life expectancy, the mortality of the lowest economic status was 2.48 times higher in men and 2.02 times higher in women than that in the highest economic status. Economic status–mortality association in males older than the average life expectancy was attenuated but not eliminated. However, there is no significant relationship between economic status and mortality for females above the average life expectancy.
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Affiliation(s)
- Ji Man Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea
- Institute of Health Services Research, Yonsei University, Seoul, Korea
- National Health Insurance Corporation Ilsan Hospital, Goyang-si, Korea
| | - Yong-Sim Jo
- National Health Insurance Corporation, Seoul, Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Woo-Hyun Cho
- Institute of Health Services Research, Yonsei University, Seoul, Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jongwon Choi
- Division of Business Administration, Yonsei University, Seoul, Korea
| | - Hoo-Sun Chang
- Institute of Health Services Research, Yonsei University, Seoul, Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
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Grant WB, Peiris AN. Differences in vitamin D status may account for unexplained disparities in cancer survival rates between African and white Americans. DERMATO-ENDOCRINOLOGY 2012; 4:85-94. [PMID: 22928063 PMCID: PMC3427205 DOI: 10.4161/derm.19667] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Considerable disparities in cancer survival rates exist between African Americans (AAs) and white Americans (WAs). Various factors such as differences in socioeconomic status (SES), cancer stage at time of diagnosis, and treatment—which this analysis considers primary explanatory factors—have accounted for many of these differences. An additional factor not usually considered is vitamin D. Previous studies have inversely correlated higher solar ultraviolet-B (UVB) doses and serum 25-hydroxyvitamin D (25(OH)D) concentrations with incidence and/or mortality rates for about 20 types of cancer and improved survival rates for eight types of cancer. Because of darker skin pigmentation, AAs have 40% lower serum 25(OH)D concentrations than WAs. This study reviews the literature on disparities in cancer survival between AAs and WAs. The journal literature indicates that there are disparities for 13 types of cancer after consideration of SES, stage at diagnosis and treatment: bladder, breast, colon, endometrial, lung, ovarian, pancreatic, prostate, rectal, testicular, and vaginal cancer; Hodgkin lymphoma and melanoma. Solar UVB doses and/or serum 25(OH)D concentrations have been reported inversely correlated with incidence and/or mortality rates for all of these cancers. This finding suggests that future studies should consider serum 25(OH)D concentrations in addressing cancer survival disparities through both measurements of serum 25(OH)D concentrations and increasing serum 25(OH)D concentrations of those diagnosed with cancer, leading to improved survival rates and reduced disparities.
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Yi M, Liu P, Li X, Mittendorf EA, He J, Ren Y, Nayeemuddin K, Hunt KK. Comparative analysis of clinicopathologic features, treatment, and survival of Asian women with a breast cancer diagnosis residing in the United States. Cancer 2012; 118:4117-25. [PMID: 22460701 DOI: 10.1002/cncr.27399] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 11/18/2011] [Accepted: 11/28/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND It has been established that disparities by ethnicity in the rates of breast cancer diagnoses and disease-specific survival (DSS) exist in the United States. However, few studies have assessed differences specifically between Asians and other ethnic groups or among Asian subgroups. METHODS The authors used the Surveillance, Epidemiology, and End Results database to identify patients who were diagnosed with invasive breast cancer between 1988 and 2008. Clinicopathologic features, treatment, and DSS rates were compared among broad ethnic groups and among Asian subgroups. RESULTS In total, there were 658,691 patients in the study, including 511,701 non-Hispanic white (NHW) women (77.7%), 57,890 black women (8.8%), 45,461 Hispanic white (HW) women (6.9%), and 43,639 Asian women (6.6%). The Asian cohort was divided into the following subgroups: Filipino, Chinese, Japanese, Indian/Pakistani, Korean, Vietnamese, Hawaiian/Pacific Islander, and other. Patients in all the Asian subgroups, except Japanese, were younger at diagnosis than NHW patients. After adjustment for disease stage, Japanese patients diagnosed with stage I through III disease had better DSS rates than patients in the NHW group or in the other Asian subgroups. Hawaiian/Pacific Islander patients with stage III or IV disease had worse DSS rates than NHW patients and patients in the other Asian subgroups. All other Asian subgroups had DSS rates similar to the DSS rate in the NHW group. [Formula: see text] CONCLUSIONS The current results indicated that disparities exist for Asian women with breast cancer who reside in the United States compared with NHW groups and among Asian subgroups. Differences in presenting clinicopathologic features may affect DSS rates, suggesting that further investigation of these disparities is warranted to increase early detection and treatment for specific subgroups.
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Affiliation(s)
- Min Yi
- Department of Translational Medicine, The First Affiliated Hospital of Xian Jiaotong University, School of Medicine, Xian, China.
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Banegas MP, Li CI. Breast cancer characteristics and outcomes among Hispanic Black and Hispanic White women. Breast Cancer Res Treat 2012; 134:1297-304. [PMID: 22772379 DOI: 10.1007/s10549-012-2142-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 06/13/2012] [Indexed: 10/28/2022]
Abstract
Evaluating breast cancer outcomes specific to Hispanics of different race (e.g. Hispanic Black, Hispanic White) may further explain variations in the burden of breast cancer among Hispanic women. Using data from the SEER 17 population-based registries, we evaluated the association between race/ethnicity and tumor stage, hormone receptor status, and breast cancer-specific mortality. The study cohort of 441,742 women, aged 20-79, who were diagnosed with primary invasive breast cancer between January 1, 1992 and December 31, 2008, included 44,246 Hispanic whites, 622 Hispanic Blacks, 44,797 non-Hispanic Blacks and 352,077 non-Hispanic whites. Hispanic black, Hispanic white and non-Hispanic black women had a 1.5-2.5 fold greater risk of presenting with stage IV breast cancer compared to non-Hispanic whites. All groups were significantly more likely than non-Hispanic whites to be diagnosed with ER+/PR- (1.1-1.5 fold increase) or ER-/PR- (1.4-2.2 fold increase) breast cancer. Hispanic black, Hispanic white and non-Hispanic black women had a 10-50 % greater risk of breast cancer-specific mortality compared to non-Hispanic whites. Our findings underscore the breast cancer disparities that continue to exist for Hispanic and black women, overall, as well as between Hispanic women of different race. These disparities highlight the factors that may lead to the poor outcomes observed among Hispanic and black women diagnosed with breast cancer, and for which targeted strategies aimed at reducing breast cancer disparities could be developed.
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Affiliation(s)
- Matthew P Banegas
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, P.O. Box 19024 (M3-B232), Seattle, WA 98109, USA.
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Nuño M, Mukherjee D, Elramsisy A, Nosova K, Lad SP, Boakye M, Yu JS, Black KL, Patil CG. Racial and Gender Disparities and the Role of Primary Tumor Type on Inpatient Outcomes Following Craniotomy for Brain Metastases. Ann Surg Oncol 2012; 19:2657-63. [DOI: 10.1245/s10434-012-2353-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Indexed: 11/18/2022]
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Chagpar AB, Crutcher CR, Cornwell LB, McMasters KM. Primary tumor size, not race, determines outcomes in women with hormone-responsive breast cancer. Surgery 2011; 150:796-801. [PMID: 22000193 DOI: 10.1016/j.surg.2011.07.066] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 07/18/2011] [Indexed: 01/17/2023]
Abstract
INTRODUCTION We sought to determine if there was a difference in outcomes in African-American compared with Caucasian women with hormone-responsive breast cancer, and whether this was related to race or other tumor and treatment variables. METHODS We included 1,205 patients with hormone-responsive breast cancer were identified in the Kentucky Cancer Registry (1996-2007). The effect of race on survival was evaluated using Kaplan-Meier and Cox regression methodologies. RESULTS In this cohort, 76.9% were Caucasian and 21.7% were African American. Compared with Caucasians, African-American women were older (57 vs 55 years; P = .032) and more likely to have larger tumors (19 vs 17 mm; P = .009). No significant racial differences in grade, operative, or systemic treatment were noted. Univariate analysis found no significant differences in disease-specific overall survival (DSS) or disease-free survival (DFS) between Caucasians and African Americans (5-year actuarial DSS, 93.6% vs 90.7%, respectively; P = .205; 5-year actuarial DFS, 91.5% vs 90.4%, respectively; P = .829). On multivariate analysis, only tumor size remained an independent predictor of DSS (odds ratio [OR], 1.021; 95% confidence interval [CI], 1.013-1.028; P < .001). Controlling for age, tumor size, and insurance status, race did not influence DSS or DFS (P = .913 and P = .857). CONCLUSION African Americans present with larger tumors than Caucasians; treatment is similar. Tumor size, not race, affects disease-specific outcomes in patients with breast cancer.
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Affiliation(s)
- Anees B Chagpar
- Department of Surgery, Yale University, New Haven, CT 06510, USA.
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Hoomans T, Ament AJHA, Evers SMAA, Severens JL. Implementing guidelines into clinical practice: what is the value? J Eval Clin Pract 2011; 17:606-14. [PMID: 21029273 DOI: 10.1111/j.1365-2753.2010.01557.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
RATIONALE AND OBJECTIVE In budget-constrained health systems, decision makers need to consider both the costs and effects of introducing and actively implementing clinical guidance. We aim to demonstrate how, as an alternative to conventional methods, a total net benefit approach to economic evaluation can be used to inform decision making about guidelines and specific implementation strategies, like education or financial incentives. METHODS Aside from providing more detail on the decision framework, we describe how to collect and analyse the relevant data for calculating the total net benefit of guideline use and the value of implementation. We illustrate the process of decision analysis for a stylized example on improving diabetes care in the UK. For the analysis, economic evidence on intensified glycemic control and that on audit and feedback to promote control is combined with information on diabetes practice. RESULTS Our illustration demonstrates that the total net benefit of guideline use and the value of implementation can vary substantially, depending on the clinical intervention chosen, the health system being studied and the specific implementation strategies. This also holds for the threshold value for cost-effectiveness, the duration of guideline usage or validity, the size of the patient population served, and the trends and ceiling rates in the implementation of clinical guidance. CONCLUSIONS In comparison with conventional methods for health economic evaluation, a total net benefit approach allows for the explicit consideration of the current (or future) use of guidelines or guideline recommendations, the cost of implementation and the scope of clinical practice. Decisions made on the basis of the total net benefit of all plausible combinations of clinical guidance and implementation strategies provide optimal patient care and an efficient use of resources.
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Affiliation(s)
- Ties Hoomans
- Section of Hospital Medicine, Department of Medicine, The University of Chicago, Chicago, IL 60637, USA.
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Gold HT, Sorbero MES, Griggs JJ, Do HT, Dick AW. Structural estimates of treatment effects on outcomes using retrospective data: an application to ductal carcinoma in situ. Med Care Res Rev 2011; 68:627-49. [PMID: 21602195 DOI: 10.1177/1077558711408324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Analysis of observational cohort data is subject to bias from unobservable risk selection. The authors compared econometric models and treatment effectiveness estimates using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare claims data for women diagnosed with ductal carcinoma in situ. Treatment effectiveness estimates for mastectomy and breast-conserving surgery (BCS) with or without radiotherapy were compared using three different models: simultaneous-equations model, discrete-time survival model with unobserved heterogeneity (frailty), and proportional hazards model. Overall trends in disease-free survival (DFS), or time to first subsequent breast event, by treatment are similar regardless of the model, with mastectomy yielding the highest DFS over 8 years of follow-up, followed by BCS with radiotherapy, and then BCS alone. Absolute rates and direction of bias varied substantially by treatment strategy. DFS was underestimated by single-equation and frailty models compared with the simultaneous-equations model and randomized controlled trial results for BCS with radiotherapy and overestimated for BCS alone.
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Affiliation(s)
- Heather Taffet Gold
- Department of Medicine, Division of General Internal Medicine, New York University School of Medicine and Cancer Institute, USA.
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Park MJ, Chung W, Lee S, Park JH, Chang HS. [Association between socioeconomic status and all-cause mortality after breast cancer surgery: nationwide retrospective cohort study]. J Prev Med Public Health 2010; 43:330-40. [PMID: 20689359 DOI: 10.3961/jpmph.2010.43.4.330] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES This study aims to evaluate and explain the socioeconomic inequalities of all-cause mortality after breast cancer surgery in South Korea. METHODS This population based study included all 8868 females who underwent radical mastectomy for breast cancer between January 2002 and June 2003. Follow-up for mortality continued from January 2002 to June 2006. The patients were divided into 4 socioeconomic classes according to their socioeconomic status as defined by the National Health Insurance contribution rate. The relationship between socioeconomic status and all-cause mortality after breast cancer surgery was assessed using the Cox proportional hazards model with adjusting for age, the Charlson's index score, emergency hospitalization, the type of hospital and the hospital ownership. RESULTS Those in the lowest socioeconomic status group had a significantly higher hazard ratio of 2.09 (95% CI =1.50 - 2.91) compared with those in the highest socioeconomic group after controlling for all the identifiable confounding variables. For all-cause mortality after radical mastectomy, all the other income groups showed significantly higher 3-year mortality rates than did the highest income group. CONCLUSIONS The socioeconomic status of breast cancer patients should be considered as an independent prognostic factor that affects all-cause mortality after radical mastectomy, and this is possibly due to a delayed diagnosis, limited access or minimal treatment leading to higher mortality. This study may provide tangible support to intensify surveillance and treatment for breast cancer among low socioeconomic class women.
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Affiliation(s)
- Mi Jin Park
- Graduate School of Public Health, Yonsei University, Korea.
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Ooi SL, Martinez ME, Li CI. Disparities in breast cancer characteristics and outcomes by race/ethnicity. Breast Cancer Res Treat 2010; 127:729-38. [PMID: 21076864 DOI: 10.1007/s10549-010-1191-6] [Citation(s) in RCA: 222] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 09/21/2010] [Indexed: 11/28/2022]
Abstract
Disparities in breast cancer stage and mortality by race/ethnicity in the United States are persistent and well known. However, few studies have assessed differences across racial/ethnic subgroups of women broadly defined as Hispanic, Asian, or Pacific Islander, particularly using more recent data. Using data from 17 population-based cancer registries in the Surveillance, Epidemiology, and End Results (SEER) program, we evaluated the relationships between race/ethnicity and breast cancer stage, hormone receptor status, treatment, and mortality. The cohort consisted of 229,594 women 40-79 years of age diagnosed with invasive breast carcinoma between January 2000 and December 2006, including 176,094 non-Hispanic whites, 20,486 Blacks, 15,835 Hispanic whites, 14,951 Asians, 1,224 Pacific Islanders, and 1,004 American Indians/Alaska Natives. With respect to statistically significant findings, American Indian/Alaska Native, Asian Indian/Pakistani, Black, Filipino, Hawaiian, Mexican, Puerto Rican, and Samoan women had 1.3-7.1-fold higher odds of presenting with stage IV breast cancer compared to non-Hispanic white women. Almost all groups were more likely to be diagnosed with estrogen receptor-negative/progesterone receptor-negative (ER-/PR-) disease with Black and Puerto Rican women having the highest odds ratios (2.4 and 1.9-fold increases, respectively) compared to non-Hispanic whites. Lastly, Black, Hawaiian, Puerto Rican, and Samoan patients had 1.5-1.8-fold elevated risks of breast cancer-specific mortality. Breast cancer disparities persist by race/ethnicity, though there is substantial variation within subgroups of women broadly defined as Hispanic or Asian. Targeted, multi-pronged interventions that are culturally appropriate may be important means of reducing the magnitudes of these disparities.
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Affiliation(s)
- Siew Loon Ooi
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M4-C308, Seattle, WA 98109-1024, USA
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