Figure 1.

Initiation of hormone therapy rates, unadjusted and adjusted odds ratios during the year following diagnosis of women aged 21–64 years with nonmetastatic HR⁺ breast cancer in New York Medicaid. (a) Region was defined as NYC, the surrounding NYC suburbs, upstate urban (counties with cities of 100 000–300 000 residents), and nonurban (counties with towns <100 000). (b) Medicaid eligibility is based on New York state government criteria. (c) Concurrently enrolled Medicare patients include those with federal disability and those who turn 65 during the follow-up period. (d) Hospital affiliation is defined as the hospital of first hospital claim in linked SPARCS files for each patient after her breast cancer diagnosis. Hospital affiliation was unassigned for 36 women (2% of the cohort). These women were dropped from the multivariable analysis. (e) Hospital size was defined by the number of hospital beds: small, <100; medium, 100–400; large, >400. (f) Hospitals were categorized by percentage of total discharges in 2006 that were not covered by insurance or were covered by Medicaid insurance to characterize hospitals based on the population they serve. (g) Comorbidity index was calculated based on inpatient and outpatient Medicaid claims during the year before breast cancer diagnosis using the Charlson–Deyo–Klabunde comorbidity index. (h) Mental health condition was identified based on Medicaid claims during the year before breast cancer diagnosis (ICD9 codes 291–2, 295–8, 300–1, 303–9, 311–2, and 648.3). (i) Stage is based on American Joint Committee on Cancer, 6th edition. Two-sided P values were calculated for the group using the Wald χ² test. The squares and lines extending outward represent point estimates and 95% confidence intervals of adjusted odds ratios, respectively. AOR = adjusted odds ratio; AHT = adjuvant hormone therapy; NYC = New York City; ER⁺ = estrogen receptor–positive; ER⁻ = estrogen receptor–negative; PR⁺ = progesterone receptor–positive; PR⁻ = progesterone receptor–negative; SPARCS = Statewide Planning and Research Cooperative System.