Assessing Health Disparities Among Female Breast Cancer Patients in Cancer Registry - Hospital Discharge Linked Dataset in Nebraska

BACKGROUND:   There still exist health disparities in Nebraska. In order to realize social justice, it is crucial to first study health condition and health care disparities across races/ethnicities. The linkage between Cancer Registry Data (CRD) and Hospital Discharge Data (HDD) can provide additional valuable information for epidemiological research, and can be used to understand cancer patients’ health conditions and health care services.

METHODS:   We propose to perform the linkage between CRD of 2000-2011 with HDD of 2000-2011 for Nebraska by using LinkPlus, and analyze the linked dataset in a cross-sectional study framework. The linkage will have two new features: 1) considering all the inpatient, outpatient, and ER visits; 2) considering HDD information before and after cancer diagnosis. Comorbid conditions of the female breast cancer patients will be grouped to cardiovascular diseases, diabete and overweight/obesity, renal diseases, pulmonary diseases, liver-related diseases, and others. For each age, racial, comorbid condition, and geographic group, Charlson comorbidity index will be calculated, and the frequency of each treatment type will be summed up. The differences of comorbidity and treatment across each population group will be described and compared from 2008-2010 with diagnosis centered in 2009. The means and variances of Charlson comorbidity indices as well as the frequencies of each comorbid condition and treatment type in each population group will be calculated. The characteristics of comorbidity and treatment will be analyzed. The comparisons of comorbidity and treatment disparities between different racial/ethnic groups and between rural and urban areas will be performed using chi-square test.

RESULTS:   The number of female breast cancer patients ranges for Nebraska in 2009 from 40 for American Indians to 12,032 for non-Hispanic Whites. High percentage of the breast cancer patients that have comorbidity profiles is expected. Significant comorbidity differences and treatment differences across racial/ethnic groups and geographic areas are expected in Nebraska.

CONCLUSIONS:   High percentage of the subjects that have comorbidity profiles is expected because the subjects will likely visit hospitals when those severe comorbid diseases occur. Significant health disparities across racial/ethnic groups and geographic areas are expected, because disparities of many risk factors across racial/ethnic groups exist in Nebraska and because health care resources are concentrated in the urban areas. This research aims to provide the information of health disparities to the authority by using CRD-HDD linked dataset, which helps to eliminate the source of disparities.