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Breast Cancer Survival In Canada And The Usa: Meta-Analytic Evidence Of A Canadian Advantage In Low-Income Areas, Kevin M. Gorey
Breast Cancer Survival In Canada And The Usa: Meta-Analytic Evidence Of A Canadian Advantage In Low-Income Areas, Kevin M. Gorey
Social Work Publications
BACKGROUND: This study tested the hypothesis that relatively poor Canadian women with breast cancer have a survival advantage over their counterparts in the USA.
METHODS: Seventy-eight independent retrospective cohort (incidence between 1984 and 2000, followed until 2006) outcomes were synthesized. Fixed effects meta-regression models compared women with breast cancer in low-income areas of Canada and the USA.
RESULTS: Low-income Canadian women were advantaged on survival [rate ratio (RR) = 1.14; 95% confidence interval (CI) 1.13-1.15] and their advantage was even larger among women <65 years of age who are not yet eligible for Medicare coverage in the USA (RR = 1.21, 95% CI 1.18-1.24). Canadian advantages were also larger for node positive breast cancer, which may present with greater clinical and managerial discretion (RR = 1.40, 95% CI 1.30-1.50), and smaller when Hawaii, the state providing the most Canadian-like access, was the US comparator (RR = 1.12, 95% CI 1.01-1.20).
CONCLUSIONS: More inclusive health care insurance coverage in Canada vs the USA, particularly among each country's relatively …
Increased Racial Differences On Breast Cancer Care And Survival In America: Historical Evidence Consistent With A Health Insurance Hypothesis, 1975-2001, Kevin M. Gorey
Social Work Publications
PURPOSE: This study examined whether race/ethnicity had differential effects on breast cancer care and survival across age strata and cohorts within stages of disease.
METHODS: The Detroit Cancer Registry provided 25,997 breast cancer cases. African American and non-Hispanic white, older Medicare-eligible and younger non-eligible women were compared. Successive historical cohorts (1975-1980 and 1990-1995) were, respectively, followed until 1986 and 2001.
RESULTS: African American disadvantages on survival and treatments increased significantly, particularly among younger women who were much more likely to be uninsured. Within node positive disease all treatment disadvantages among younger African American women disappeared with socioeconomic adjustment.
CONCLUSIONS: Growth …