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Care and Survival of Mexican American Women with Node Negative Breast Cancer: Historical Cohort Evidence of Health Insurance and Barrio Advantages

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Abstract

We hypothesized 3-way ethnicity by barrio by health insurance interactions such that the advantages of having adequate health insurance were greatest among Mexican American (MA) women who lived in barrios. Barrios were neighborhoods with relatively high concentrations of MAs (60 % or more). Data were analyzed for 194 MA and 2,846 non-Hispanic white women diagnosed with, very treatable, node negative breast cancer in California between 1996 and 2000 and followed until 2011. Significant interactions were observed such that the protective effects of Medicare or private health insurance on radiation therapy access and long term survival were largest for MA women who resided in MA barrios, neighborhoods that also tended to be extremely poor. These paradoxical findings are consistent with the theory that more facilitative social and economic capital available to MA women in barrios enables them to better absorb the indirect and direct, but uncovered, costs of breast cancer care.

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Acknowledgments

The authors gratefully acknowledge the administrative and logistical assistance of Kurt Snipes, Janet Bates and Gretchen Agha of the Chronic Disease Surveillance and Research Branch, California Department of Public Health. We also gratefully acknowledge the research and technical assistance of Daniel Edelstein and Madhan Balagurusamy of the University of Windsor and Mark Allen, Allyn Fernandez-Ami and Arti Parikh-Patel of the California Cancer Registry. Finally, we are grateful for the assistance received from Eric Holowaty of the University of Toronto and GuangYong Zou and Caroline Hamm of the University of Western Ontario in obtaining funding. This research was supported in part with funds from the Canadian Institutes of Health Research (Grant No. 67161-2). The funder had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The collection of cancer incidence data was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement U58DP003862-01 awarded to the California Department of Public Health. The ideas and opinions expressed herein are those of the authors and endorsement by the State of California, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors are not intended nor should be inferred.

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Authors and Affiliations

  1. School of Social Work, University of Windsor, 401 Sunset Avenue, Windsor, ON, N9B 3P4, Canada

    Nancy L. Richter, Kevin M. Gorey & Sundus Haji-Jama

  2. Department of Geography, University of Western Ontario, London, ON, Canada

    Isaac N. Luginaah

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  1. Nancy L. Richter
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  2. Kevin M. Gorey
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  4. Isaac N. Luginaah
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Correspondence to Kevin M. Gorey.

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Richter, N.L., Gorey, K.M., Haji-Jama, S. et al. Care and Survival of Mexican American Women with Node Negative Breast Cancer: Historical Cohort Evidence of Health Insurance and Barrio Advantages. J Immigrant Minority Health 17, 652–659 (2015). https://doi.org/10.1007/s10903-013-9941-2

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