Table 4.
Racial/Ethnic Disparities in Palliative Care Use Among Patients With Metastatic Breast Cancer
| Characteristic | Model 1 |
Model 2 |
Model 3 |
|---|---|---|---|
| aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | |
| Race/Ethnicity | |||
| White | 1.0 (Reference) | 1.0 (Reference) | 1.0 (Reference) |
| Black | 0.91 (0.88 to 0.94)*** | 0.88 (0.84 to 0.91)*** | 0.89 (0.84 to 0.94)*** |
| Asian | 0.74 (0.68 to 0.81)*** | 0.74 (0.67 to 0.81)*** | 0.76 (0.68 to 0.86)*** |
| American Indian or Alaska Native | 0.99 (0.80 to 1.24) | 1.00 (0.77 to 1.29) | 1.11 (0.80 to 1.53) |
| Hawaiian or Other Pacific Islander | 0.80 (0.62 to 1.04) | 0.83 (0.63 to 1.11) | 0.71 (0.47 to 1.05) |
| Hispanic | 0.67 (0.64 to 0.72)*** | 0.65 (0.61 to 0.70)*** | 0.68 (0.62 to 0.74)*** |
| Year of initial diagnosis (per one-year increase) | 1.05 (1.04 to 1.05)*** | 1.05 (1.04 to 1.05)*** | 1.05 (1.04 to 1.06)*** |
| Age at diagnosis (per 10-year increase) | 0.96 (0.95 to 0.98)*** | 0.98 (0.96 to 0.999)* | |
| Sex | |||
| Male | 1.0 (Reference) | 1.0 (Reference) | |
| Female | 0.99 (0.88 to 1.11) | 1.01 (0.86 to 1.19) | |
| Type of health insurance | |||
| Uninsured | 1.21 (1.13 to 1.29)*** | 1.28 (1.17 to 1.41)*** | |
| Private or managed care | 1.0 (Reference) | 1.0 (Reference) | |
| Medicaid | 1.12 (1.06 to 1.17)*** | 1.15 (1.08 to 1.23)*** | |
| Medicare | 1.04 (0.99 to 1.08) | 1.02 (0.97 to 1.08) | |
| Other government or unknown | 0.79 (0.72 to 0.87)*** | 0.88 (0.76 to 1.02) | |
| Median household income quartilea | |||
| <$40,227 | 1.02 (0.97 to 1.06) | 1.05 (0.99 to 1.11) | |
| $40,227–$50,353 | 1.06 (1.02 to 1.10)** | 1.08 (1.02 to 1.14)** | |
| $50,354–$63,332 | 1.04 (1.00 to 1.08) | 1.09 (1.04 to 1.15)** | |
| ≥$63,333 | 1.0 (Reference) | 1.0 (Reference) | |
| Rural/urban areab | |||
| Metro | 1.0 (Reference) | 1.0 (Reference) | |
| Urban | 1.20 (1.15 to 1.26)*** | 1.15 (1.08 to 1.22)*** | |
| Rural | 1.02 (0.91 to 1.14) | 1.02 (0.87 to 1.19) | |
| Charlson–Deyo comorbidity score | |||
| 0 | 1.0 (Reference) | 1.0 (Reference) | |
| 1 | 1.11 (1.06 to 1.16)*** | 1.11 (1.05 to 1.18)*** | |
| ≥2 | 1.18 (1.12 to 1.25)*** | 1.25 (1.15 to 1.35)*** | |
| Type of cancer program | |||
| Community | 1.0 (Reference) | 1.0 (Reference) | |
| Comprehensive community | 1.14 (1.08 to 1.20)*** | 1.06 (0.98 to 1.15) | |
| Academic or research | 1.16 (1.10 to 1.23)*** | 1.08 (1.00 to 1.17) | |
| Integrated network | 1.33 (1.26 to 1.42)*** | 1.27 (1.17 to 1.38)*** | |
| Histologic type | |||
| Ductal | 1.0 (Reference) | ||
| Lobular | 0.93 (0.87 to 0.99)* | ||
| Ductal and lobular | 0.95 (0.86 to 1.06) | ||
| Other | 0.94 (0.88 to 0.99)* | ||
| Molecular subtype | |||
| HR+/HER2− | 1.03 (0.97 to 1.09) | ||
| HR+/HER2+ | 0.95 (0.89 to 1.03) | ||
| HR−/HER2+ | 0.84 (0.77 to 0.92)*** | ||
| TNBC | 1.0 (Reference) | ||
| Tumor grade | |||
| 1 | 1.07 (0.99 tot 1.16) | ||
| 2 | 1.05 (1.00 to 1.09)* | ||
| 3 | 1.0 (Reference) | ||
a
Based on the 2016 American Community Survey data, spanning years 2012–2016 and adjusted for 2016 inflation.
b
Measured by matching the state and county FIPS code of the patient recorded at the time of diagnosis against 2013 files published by the United States Department of Agriculture Economic Research Service.
*
p < 0.05; **p < 0.01; ***p < 0.001.
aOR, adjusted odds ratio.