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Socioeconomic Disparities in Mortality Among Women With Incident Breast Cancer Before and After Implementation of Medicare Part D. Med Care 2017 05;55(5):463-469 PMID: 28030476 PMCID: PMC5391268

Pubmed ID



BACKGROUND: Breast cancer patients exhibit survival disparities based on socioeconomic status (SES). Disparities may be attributable to access to expensive oral endocrine agents.

OBJECTIVES: Define recent socioeconomic disparities in breast cancer survival and determine whether these improved after implementation of the Medicare Part D program.

DESIGN: Difference-in-difference natural experiment of women diagnosed and treated before or after implementation of Medicare Part D.

SUBJECTS: Female Medicare beneficiaries with early-stage breast cancer: 54,772 diagnosed in 2001 and 46,371 in 2007.

MEASURES: SES was based on Medicaid enrollment and zip code per capita income, all-cause mortality from Medicare, and cause of death from National Death Index.

RESULTS: Among women diagnosed pre-Part D, 40.5% of poor beneficiaries had died within 5 years compared with 20.3% of high-income women (P<0.0001). Post-Part D, 33.6% of poor women and 18.4% of high-income women died by 5 years. After adjustment for potential confounders, improvement in all-cause mortality post-Part D was greater for poorer women compared with more affluent women (P=0.002). However, absolute improvement in breast cancer-specific mortality was 1.8%, 1.2%, and 0.8% (P=0.88 for difference in improvement by SES), respectively for poor, near-poor, and high-income women, whereas analogous improvement in mortality from other causes was 5.1%, 3.8%, and 0.9% (P=0.067 for difference in improvement by SES).

CONCLUSIONS: Large survival disparities by SES exist among breast cancer patients. The Part D program successfully ameliorated SES disparities in all-cause mortality. However, improvement was concentrated in causes of death other than breast cancer, suggesting remaining gaps in care.

Author List

Nattinger AB, Wozniak EM, McGinley EL, Li J, Laud P, Pezzin LE


Purushottam W. Laud PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Ann B. Nattinger MD, MPH Associate Provost, Professor in the Medicine department at Medical College of Wisconsin
Liliana Pezzin PhD, JD Professor in the Medicine department at Medical College of Wisconsin


2-s2.0-85007453737   4 Citations

MESH terms used to index this publication - Major topics in bold

Breast Neoplasms
Ethnic Groups
Health Services Accessibility
Healthcare Disparities
Medicare Part D
Middle Aged
Social Class
United States
jenkins-FCD Prod-300 626508253d14e4184314fb9f66322a03a5906796