Abstract
The purpose of this study was to examine factors contributing to the ethnic discrepancies
in breast cancer survival described previously. Through the use of the Hawaii Tumor
Registry and insurance claims data, 1,052 breast cancer patients' survival times were
examined in relation to demographics, disease characteristics, comorbidity, and treatment
patterns as compared to national guidelines for breast cancer treatment. In stepwise
and hierarchical Cox regression models, TNM stage was the strongest predictor of survival
and explained all of the ethnic survival differences. In addition, comorbidity and
treatment patterns were significant in predicting survival. In this population of
health plan members, ethnic differences in survival were not a result of differential
treatment, but due to variations in early detection. These results support the hypothesis
that pre-existing conditions and treatment patterns are related to breast cancer survival
even after controlling for stage at diagnosis indicating the usefulness of insurance
claims data in this research field.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Clinical EpidemiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Ethnic differences and factors related to breast cancer survival in Hawaii.Int J Epidemiol. 1997; 26: 1151-1158
- Racial differences in survival from breast cancer. Results of the National Cancer Institute black/white cancer survival study.JAMA. 1994; 272: 947-954
- Racial/ethnic differences in breast cancer survival among San Francisco Bay area women.J Natl Cancer Inst. 1997; 89: 1311-1312
- Breast cancer survival and treatment in health maintenance organization and fee-for-service settings.J Natl Cancer Inst. 1997; 89: 1683-1691
- Socioeconomic factors and race in breast cancer recurrence and survival.Am J Epidemiol. 1992; 135: 609-618
- Black–white differences in stage-specific cancer survival: analysis of seven selected sites.Am J Epidemiol. 1991; 133: 672-682
- Comorbidity and breast cancer survival: a comparison between black and white women.Ann Epidemiol. 1996; 6: 413-419
- The effect of age and comorbidity in the treatment of elderly women with nonmetastic breast cancer.Arch Intern Med. 1996; 156: 85-90
- Socioeconomic status and comorbidity among newly diagnosed cancer patients.Cancer. 1997; 80: 1482-1488
- Using administrative data for longitudinal research: comparisons with primary data collection.J Chronic Dis. 1987; 40: 41-49
- International Classification of Disease. ICD-9-CM.Medicode, Salt Lake City1995
- Physician's current procedural terminology—cpt '95. AMA, Chicago, IL1994
- Potential for cancer related health services research using a linked Medicare-tumor registry database.Med Care. 1993; 31: 732-748
- Using administrative data for case–control studies: the case of the Papanicolaou smear.Ann Epidemiol. 1993; 3: 93-98
- The role of increasing detection in the rising incidence of prostate cancer.JAMA. 1995; 273: 548-552
- Mammography screening and the increase in breast cancer incidence in Hawaii.Cancer Epidemiol Biomarkers Prev. 1997; 6: 201-208
- Health trends in Hawaii. HMSA, Honolulu1997
- State of Hawaii data book 1997: a statistical abstract. State of Hawaii, Honolulu1998
- Descriptive epidemiology of thyroid cancer in Hawaii.Cancer. 1988; 61: 1272-1281
- Manual for staging of cancer. Lippincott, Philadelphia1992
- SEER extent of disease—1988 codes and coding instructions. National Cancer Institute, 1992 (NIH Publication No. 92–2313)
National Cancer Institute. PDQ®—NCI's comprehensive cancer database. http://cancernet.nci.nih.gov/pdqfull.html. 2001 (accessed 10/3/01).
- Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.J Clin Epidemiol. 1992; 45: 613-619
- Categorical data analysis using the SAS system. 2nd ed. SAS Institute Inc, Cary, NC2000
- Relationship of ethnicity and other prognostic factors to breast cancer survival patterns in Hawaii.J Natl Cancer Inst. 1984; 73: 1259-1265
- Social class and cancer patient survival in Finland.Am J Epidemiol. 1995; 142: 1089-1102
- Breast carcinoma survival analysis for African American and white women in an equal-access health care system.Cancer. 1998; 82: 1310-1318
- Diminished socioeconomic and racial disparity in the detection of early- stage breast cancer, Connecticut, 1986–1995.Ethn Dis. 1999; 9: 396-402
- Trends in cancer survival among different ethnic groups in Hawaii.Cancer Strat. 1999; 1: 175-182
- Influence of clinician workload and patterns of treatment on survival from breast cancer.Lancet. 1995; 345: 1265-1270
- The effect of comorbidity on 3-year survival of women with primary breast cancer.Ann Intern Med. 1994; 120: 104-110
- Estrogen receptor determination and long term survival of patients with carcinoma of the breast.Surg Gynecol Obstet. 1991; 173: 273-278
- Medical insurance claims as a source of data for research: accuracy of diagnostic coding.Hawaii Med J. 1996; 55: 9-11
- The accuracy of Medicare's hospital claims data: progress has been made, but problems remain.Am J Public Health. 1992; 82: 243-248
- Ethnic differences in risk and prognostic factors for breast cancer.Cancer. 1995; 76: 268-274
- Histopathological predictors of breast cancer death among Caucasians and Japanese in Hawaii.Cancer Epidemiol Biomarkers Prev. 1993; 2: 201-205
- The effect of dietary fat on breast cancer survival among Caucasian and japanese women in Hawaii.Breast Cancer Res Treat. 1991; 18: S135-S141
- Diet and subsequent survival in women with breast cancer.Br J Cancer. 1994; 69: 592-595
- Social class and weight as prognostic factors in early breast cancer.Br J Cancer. 1997; 75: 729-733
Article info
Identification
Copyright
© 2003 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
