Table 5:
Association of healthcare affordability, accessibility and availability with initiation of guideline-recommended systemic therapy (stage and histology specific) among Non-Hispanic Black, Hispanic and Non-Hispanic White patients (N=7,702)
| Parameter | Model 1 | Model 2 | Model 3 | Model 4 | Model 5 |
|---|---|---|---|---|---|
| Clinical | Clinical + Affordability | Clinical + Accessibility | Clinical+Availability | All covariates | |
| Race (ref: Non-Hispanic White) | |||||
| Non-Hispanic Black | 0.96 (0.92–1.01) | 0.98 (0.93–1.03) | 0.97 (0.93–1.01) | 0.97 (0.93–1.01) | 0.98 (0.94–1.03) |
| Hispanic | 1.00 (0.96–1.03) | 1.03 (0.99–1.07) | 1.00 (0.97–1.04) | 1.00 (0.97–1.04) | 1.02 (0.99–1.06) |
| Age at diagnosis (ref: 65–70) | |||||
| 71–75 | 0.99 (0.97–1.02) | * | * | * | * |
| 76–80 | 0.94 (0.91–0.96) | * | * | * | * |
| 81+ | 0.81 (0.78–0.83) | * | * | * | * |
| Stage at diagnosis (ref: IV) | |||||
| I | 1.15 (1.11–1.19) | * | * | * | * |
| II | 1.08 (1.03–1.12) | * | * | * | * |
| III | 1.09 (1.07–1.12) | * | * | * | * |
| Tumor histology (ref: Type I epithelial) | |||||
| Type II epithelial | 1.03 (0.99–1.06) | * | * | * | * |
| Other | 0.52 (0.37–0.74) | * | * | * | * |
| Married | 1.05 (1.03–1.07) | * | * | * | * |
| Dual enrolled in Medicaid | 0.92 (0.88–0.95) | 0.94 (0.92–0.97) | |||
| Census tract in highest quartile: | |||||
| Adults < high school education | 0.99 (0.96–1.02) | 1.00 (0.97–1.02) | |||
| Residents of Black race | 1.02 (0.99–1.04) | 1.01 (0.98–1.03) | |||
| Households in poverty | 0.99 (0.96–1.02) | 1.00 (0.97–1.02) | |||
| % county residents without health insurance | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | |||
| Lives in metro area | 1.02 (0.99–1.05) | 1.00 (0.97–1.03) | |||
| Distance to treatment facility (ref: 0–5 miles) | |||||
| 5–10 miles | 1.01 (0.99–1.04) | 1.00 (0.98–1.03) | |||
| 10–20 miles | 1.02 (1.00–1.05) | 1.01 (0.99–1.04) | |||
| 20–50 miles | 1.02 (0.99–1.05) | 1.01 (0.98–1.04) | |||
| 50+ miles | 1.01 (0.98–1.05) | 1.00 (0.96–1.03) | |||
| Missing | 0.71 (0.51–0.99) | 0.77 (0.58–1.01) | |||
| PCPs per 1K county population | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | |||
| HRR: % Hospital discharges 30-day readmission | 1.01 (0.99–1.02) | 1.00 (0.99–1.02) | |||
| HRR: % Hospital discharges 30-day ER visit | 1.00 (1.00–1.01) | 1.00 (0.99–1.01) | |||
| HRR: Physicians per 100k population | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | |||
| HRR: Heme/Onc per 100k population | 1.02 (1.00–1.04) | 1.02 (1.00–1.04) | |||
| HRR: Ob-Gyns per 100k women aged 15–44 | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | |||
| HRR: % Medicare patients died diagnosis year | 1.00 (0.96–1.03) | 0.99 (0.95–1.03) | |||
| HRR: % Medicare patients saw PCP diagnosis year | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | |||
| HRR: Ambulatory sensitive discharges per 1K | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | |||
| Main facility: highest OC surgical volume (age 65+ only) | 1.02 (1.00–1.04) | 0.93 (0.87–1.00) | |||
| Main facility: affiliated with medical school | 0.99 (0.97–1.01) | 0.99 (0.97–1.01) | |||
| Main facility: has NCI cancer center | 1.02 (0.99–1.05) | 1.01 (0.99–1.04) |
Log-binomial regression for relative risk (RR) of initiating a recommended systemic therapy in the 12 months following OC diagnosis. Affordability, accessibility, and availability metrics were added in stages. All models additionally adjusted for patient geographic region and patient comorbid conditions.
Included in model but estimates not shown.
Abbreviations: primary care physician (PCP); healthcare referral region (HRR); ovarian cancer (OC); hematologic oncologist (HemeOnc); obstetrician-gynecologist (Ob-Gyn); emergency room (ER); National Cancer Institute (NCI).