Insurance coverage, personal, and clinical factors as determinants of breast cancer treatment delay

Health insurance impacts all stages of the breast cancer care continuum. Previous studies evaluating the influence of insurance coverage and treatment delay on breast cancer outcomes have typically relied on group-level data to characterize individual socioeconomic status and combined disparate types of insurance coverage. The goals of this study were 1) to identify factors associated with delay between diagnosis and first course of treatment and 2) to evaluate the association between insurance coverage and delay while accounting for socioeconomic factors. The Carolina Breast Cancer Study is a population-based study of women with invasive breast cancer in North Carolina. Data on socioeconomic status, past healthcare access, patient and clinical factors, and emotional and functional well-being were collected from 771 participants through interviews, questionnaires, and medical record data. We examined the association of these factors with delay (treatment delay >30 days), insurance coverage, and race. Logistic regression was used to evaluate the association between insurance coverage and race with delay. Characteristics significantly associated with delay included a smaller household size, losing a job due to one's diagnosis, and immediate reconstruction. Insurance coverage was not significantly associated with delay in any of the models we evaluated. In the fully adjusted model, African American race was associated with delay for women less than 50 years old. Although this study found no evidence that treatment delay is affected by insurance coverage, future studies should take into account race in combination with age, household size, changes in employment status, and the timing of reconstruction.