Stephanie B. Wheeler|William R. Carpenter|Jeffrey Peppercorn|Anna P. Schenck|Morris Weinberger|Andrea K. Biddle
Structural/organizational characteristics of health services partly explain racial variation in timeliness of radiation therapy among elderly breast cancer patients
University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill|Duke Medical Center|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill
observed racialethnic disparities process outcomes breast cancer care may explained part structuralorganizational characteristics health care systems examined role surgical facility characteristics distance care explaining racialethnic variation timing initiation guidelinerecommended radiation therapy rt breast conserving surgery bcs used surveillance epidemiology end resultsmedicare data identify women ages 65 older diagnosed stages iiii breast cancer treated bcs 19942002 used stepwise multivariate logistic regression examine interactive effects raceethnicity facility profit status teaching status size institutional affiliations distance nearest rt timing rt initiation controlling known covariates among 38574 eligible women received bcs 39 received rt within 2 months 52 received rt within 6 months 57 received rt within 12 months postdiagnosis significant variation raceethnicity multivariate models women attending smaller surgical facilities onsite radiation higher odds rt time interval women attending governmental facilities lower odds rt time interval p 005 increasing distance patients residence nearest rt provider associated lower overall odds rt particularly among hispanic women p 005 fully adjusted models including racebydistance interaction terms racialethnic disparities disappeared rt initiation within 6 12 months racialethnic disparities timing rt breast cancer partially explained structuralorganizational health system characteristics identifying modifiable systemlevel factors associated quality cancer care may help us target policy interventions reduce disparities outcomes