Online Program

Breast cancer care of Mexican American women in high poverty California neighborhoods: Protective effects of social and financial capital, including health insurance, in barrios

Monday, November 4, 2013

Sundus Haji-Jama, School of Social Work, University of Windsor, Windsor, ON, Canada
Nancy L. Richter, School of Social Work, University of Windsor, Windsor, ON, Canada
Kevin M. Gorey, PhD, MSW, School of Social Work, University of Windsor
Isaac N. Luginaah, PhD, Department of Geography, Western University, London, ON, Canada
Guangyong Zou, Department of Epidemiology and Biostatistics, University of Western Ontario and Robarts Research Institute
Eric J. Holowaty, MD, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
Madhan K. Balagurusamy, School of Social Work, University of Windsor, Windsor, ON, Canada
Caroline Hamm, Schulich School of Medicine and Dentistry, University of Western Ontario and Windsor Regional Cancer Center, London, ON, Canada
Objectives. We examined health insurance mediation of Mexican American (MA) non-Hispanic white (NHW) disparities on breast cancer care and survival. Based on social capital and barrio advantage theories, we hypothesized a 3-way ethnicity by poverty by health insurance interaction, that is, that 2-way poverty by health insurance interaction effects would differ between ethnic groups. Methods. We analyzed registry data for 303 MA and 3,611 NHW women diagnosed between 1996 and 2000 and followed until 2011. Socioeconomic data were obtained from the 2000 census to categorize neighborhood poverty: high (> 30% poor), middle and low (< 5% poor). Barrios were neighborhoods where 50% or more of the residents were MA. Primary health insurers were Medicaid, Medicare, private or none. Results. MA-NHW diagnostic, treatment and survival disparities were completely mediated by the main and interacting effects of health insurance. Advantages of health insurance were largest in low poverty neighborhoods among NHW women while among MA women they were, paradoxically, largest in high poverty, MA barrios. Advantages of being privately insured were observed for all, but were particularly pronounced among MA women who resided in barrios. Medicare seemed additionally instrumental for NHW women and Medicaid for MA women. Conclusion. These findings are consistent with the theory that more facilitative social and financial capital is available to MA women in barrios and to NHW women in more affluent neighborhoods. It is there that each respective group of women is probably best able to absorb the indirect and direct, but uncovered, costs of breast cancer care.

Learning Areas:

Chronic disease management and prevention
Diversity and culture
Provision of health care to the public
Public health or related public policy
Public health or related research

Learning Objectives:
Describe the pattern of Mexican American (MA) versus non-Hispanic white (NHW) diagnostic, treatment and survival disparities that were observed among women with breast cancer in California. Differentiate places where NHW women were advantaged and where MA women were advantaged. Explain the seemingly paradoxical breast cancer care and survival advantages that were observed among some of this study's poorest MA women in light of social capital and barrio advantage theories.

Keyword(s): Health Insurance, Poverty

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a student supervised by a federally funded epidemiologist with 19 years of research experience in social epidemiology and international comparative health services research the results of which have been published in 96 peer-reviewed scientific journal articles.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.