Recorded presentation

Kevin M. Gorey, PhD, MSW, School of Social Work, University of Windsor, 401 Sunset Avenue, Windsor, ON N9B 3P4, Canada, 519 253-3000, ext. 3085, gorey@uwindsor.ca, Isaac N. Luginaah, PhD, Department of Sociology and Anthropology, University of Windsor, 401 Sunset Avenue, Windsor, ON N9B 3P4, Canada, and Kendra L. Schwartz, MD, MSPH, Department of Family Medicine, Karmanos Cancer Institute and Wayne State University, 110 E. Warren Avenue, Detroit, MI 48201.

Contemporary health care reforms in the US have emphasized costs, rather than benefits or outcomes. Consequently, as managed care strategies have proliferated so has the prevalence of under- and uninsured Americans. A retrospective study (1973-2003) of the determinants of a public health significant outcome—breast cancer survival—provided sentinel tests of this health insurance theory. African American (n = 12,622) and white (n = 59,093) women with incident breast cancer were studied in the three-county Detroit metropolitan area over two time periods: 1973-1986 and 1987-2000, respectively, followed through 1988 and 2002. Findings were then cross-validated with another aggregate metropolitan sample: San Francisco-Oakland-Seattle-Hartford. Proportional hazards models revealed three significant interactions on age-adjusted observed survival: race by period, race by stage (in situ/local vs. regional/distant), and race by age (< 65 vs. 65 and older). African American breast cancer survival disadvantages have increased over time, and they have been most pronounced among younger patients, not eligible for Medicare coverage, diagnosed with the most treatable types of breast cancer. After socioeconomic (poverty [1990 census tract-based]) main effects and all significant interactions entered regression models, the main effect of race did not. Descriptive expositions of these ‘racial’ effect modifications will be presented. They seem to be most consistent with race as a social construction, and implicate sociological, rather than biological (genetic) phenomena, including health care policies related to equitable access to early diagnosis and the best available treatments. Such policy effects probably operate nationally. They do not seem to be merely local or regional phenomena.

Learning Objectives:

• To be able to articulate how breast cancer survival advances have been differential enjoyed over the past generation (people of color and the poor disadvantaged in America).
• To be able to articulate the evidence that empirically indicts policy changes that affected access to adequate health insurance.
• To understand how obserational epidemiologic, particularly historical cohort, studies can provide practical evidence to steer future research and social policies.

Keywords: Health Care Access, Ethnic Minorities

Related Web page: www.uwindsor.ca/gorey

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation