SES Disparities in Breast Cancer: Effect of Pharmaceutical Coverage

乳腺癌中社会经济地位的差异：药物承保的影响

• 批准号: 8434001
• 负责人: Ann B Nattinger
• 金额: $ 36.32万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-03-01 至 2015-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8434001
• 关键词: Address; Adjuvant; Age; Algorithms; Attention; Cancer Patient; Cancer Survivor; Cancer Survivorship; Censuses; Cessation of life; Characteristics; Comorbidity; Data; Data Sources; Disease; Disease Outcome; Enrollment; Exhibits; Health Policy; Hormonal; Incidence; Insurance Coverage; Intention; Medicare; Medicare claim; Neighborhoods; Oral; Outcome; Pharmaceutical Preparations; Pharmacologic Substance; Policy Maker; Population; Postmenopause; Public Health; Publishing; Sampling; Socioeconomic Status; Woman; base; beneficiary; cohort; experience; hormone therapy; indexing; interest; low socioeconomic status; malignant breast neoplasm; mortality; novel; programs; public health relevance; socioeconomics

DESCRIPTION (provided by applicant): Traditionally breast cancer has been thought of as an illness subject to reverse disparities based on socioeconomic status (SES); that is, incidence and mortality rates were lower for women of lower socioeconomic levels. However, during the past two decades this situation changed. Despite breast cancer incidence rates which remained 10-20% lower for poorer populations compared to more affluent populations, breast cancer patients residing in poorer neighborhoods had 20-30% lower survival than those residing in wealthier neighborhoods by the late 1990s. It is likely that the worse survival experience of lower SES populations is attributable at least in part to lesser use of the effective but expensive oral medications that have become available for treating postmenopausal breast cancer. The advent of Part D (pharmaceutical) coverage for Medicare beneficiaries in 2006 provides an opportunity to examine the hypothesis that the availability of pharmaceutical insurance coverage will reduce socioeconomic disparities with respect to the use of adjuvant hormonal and other oral medication therapies, and therefore will reduce socioeconomic disparities in survival. The specific aims of this project are: 1) Determine, among a cohort of Medicare-eligible breast cancer patients, the characteristics of those enrolling in the Medicare Part D program, with special attention to neighborhood socioeconomic status and comorbid conditions. 2) Determine the relationship of SES, Part D enrollment, comorbidity, and mortality among a cohort of older breast cancer survivors. 3) Examine the use of adjuvant hormone therapy among breast cancer Part D enrollees and evaluate its relationship to mortality disparities by SES. These aims will be carried out by analysis of serial cohorts of Medicare breast cancer patients. A validated and published algorithm will be employed to identify national samples of Medicare breast cancer survivors with initial treatment in 2001-2008. Geocoding of addresses to census tracts will permit determination of neighborhood SES. Three-year and five-year outcomes of overall mortality and disease-specific mortality will be ascertained using Medicare claims and National Death Index data. Analyses will employ different approaches (instrumental variables and propensity scores) to controlling for endogeneity in the choice to enroll in the Medicare Part D program. Analyses to address Specific Aim 3 will utilize Medicare Part D pharmaceutical data, a novel data source. This project will have major significance for the field of breast cancer survivorship, and for those interested in reducing disparities in outcomes for that disease. It will also provide critical information to policy-makers regarding the fledgling Part D program.

描述（由申请人提供）：传统上，乳腺癌被认为是一种根据社会经济地位 (SES) 存在反向差异的疾病；也就是说，社会经济水平较低的妇女的发病率和死亡率较低。然而，在过去的二十年里，这种情况发生了变化。尽管与富裕人群相比，贫困人群的乳腺癌发病率仍然低 10-20%，但到 20 世纪 90 年代末，居住在贫困社区的乳腺癌患者的生存率比居住在富裕社区的乳腺癌患者低 20-30%。社会经济地位较低的人群的生存体验较差，这可能至少部分归因于较少使用可用于治疗绝经后乳腺癌的有效但昂贵的口服药物。 2006 年针对 Medicare 受益人的 D 部分（药物）保险的出现提供了一个检验以下假设的机会：药物保险承保的可用性将减少使用辅助激素和其他口服药物治疗方面的社会经济差距，因此将减少生存方面的社会经济差异。该项目的具体目标是： 1) 在符合 Medicare 资格的乳腺癌患者队列中确定参加 Medicare D 部分计划的患者的特征，特别关注社区社会经济状况和合并症。 2) 确定老年乳腺癌幸存者队列中 SES、D 部分入组、合并症和死亡率之间的关系。 3) 检查乳腺癌 D 部分参与者中辅助激素治疗的使用情况，并通过 SES 评估其与死亡率差异的关系。这些目标将通过对医疗保险乳腺癌患者的系列队列进行分析来实现。将采用经过验证并发布的算法来识别 2001-2008 年接受初始治疗的 Medicare 乳腺癌幸存者的全国样本。对人口普查区地址进行地理编码将有助于确定社区社会经济地位。将使用医疗保险索赔和国家死亡指数数据来确定三年和五年总体死亡率和特定疾病死亡率的结果。分析将采用不同的方法（工具变量和倾向评分）来控制选择参加 Medicare D 部分计划的内生性。解决特定目标 3 的分析将利用 Medicare D 部分药品数据，这是一种新颖的数据源。该项目对于乳腺癌生存领域以及那些有兴趣减少该疾病结果差异的人来说具有重大意义。它还将为政策制定者提供有关刚刚起步的 D 部分计划的重要信息。

项目成果

The introduction of generic aromatase inhibitors and treatment adherence among Medicare D enrollees.

通用芳香酶抑制剂的引入以及 Medicare D 参与者的治疗依从性。

• 发表时间: 2015-08
• 作者: Neuner, Joan M;Kamaraju, Sailaja;Charlson, John A;Wozniak, Erica M;Smith, Elizabeth C;Biggers, Alana;Smallwood, Alicia J;Laud, Purushottam W;Pezzin, Liliana E
• 通讯作者: Pezzin, Liliana E

Medicare D Subsidies and Racial Disparities in Persistence and Adherence With Hormonal Therapy.

Medicare D 补贴以及坚持和坚持激素治疗方面的种族差异。

• 发表时间: 2016
• 作者: Biggers, Alana;Shi, Yushu;Charlson, John;Smith, Elizabeth C;Smallwood, Alicia J;Nattinger, Ann B;Laud, Purushottam W;Neuner, Joan M
• 通讯作者: Neuner, Joan M