IBM Watson Health, 75 Binney Street, Cambridge, MA, 02142, USA.
RxEconomics LLC, Hunt Valley, MD, USA.
Breast Cancer Res Treat. 2021 Jul;188(1):259-272. doi: 10.1007/s10549-021-06155-1. Epub 2021 Mar 10.
To describe clinical and non-clinical factors associated with receipt of breast conserving surgery (BCS) versus mastectomy and time to surgical intervention.
Cross-sectional retrospective study of January 1, 2012 through March 31, 2018 data from the IBM MarketScan Commercial Claims and Encounter and Medicare Supplemental Databases. Area Health Resource Files provided non-clinical characteristics and sociodemographic data. Eligibility: Female sex, claim(s) with ICD-9-CM or ICD-10-CM diagnosis of non-metastatic invasive breast cancer, > 6 months of continuous insurance pre- and post-diagnosis, evidence of BCS or mastectomy following initial ICD9/10 code diagnosis. Logistic and quantile multivariable regression models assessed the association between clinical and non-clinical factors and the outcome of BCS and time to surgery, respectively.
A total of 53,060 women were included in the study. Compared to mastectomy, BCS was significantly associated with older age (ORs: 1.54 to 2.99, 95% CIs 1.45 to 3.38; ps < .0001) and higher community density of medical genetics (OR: 5.88, 95% CIs 1.38 to 25.00; p = 0.02) or obstetrics and gynecology (OR: 1.13, 95% CI 1.02 to 1.25; p = .02) physicians. Shorter time-to-BCS was associated with living in the South (-2.96, 95% CI -4.39 to -1.33; p < .0001). Longer time-to-BCS was associated with residence in more urban (4.18, 95% CI 0.08 to 8.29; p = 0. 05), educated (9.02, 95% CI 0.13 to 17.91; p = 0.05), or plastic-surgeon-dense (4.62, 95% CI 0.50 to 8.73; p = 0.03) communities.
Clinical and non-clinical factors are associated with adoption of BCS and time to treatment, suggesting opportunities to ensure equitable and timely care.
描述与保乳手术（BCS）与乳房切除术相关的临床和非临床因素，以及手术干预的时间。
这是一项回顾性的队列研究，纳入了 2012 年 1 月 1 日至 2018 年 3 月 31 日期间来自 IBM MarketScan 商业索赔和就诊数据库以及医疗保险补充数据库的数据。区域卫生资源文件提供了非临床特征和社会人口统计学数据。入选标准：女性，索赔中包含 ICD-9-CM 或 ICD-10-CM 诊断为非转移性浸润性乳腺癌的诊断，在诊断前和诊断后有至少 6 个月的连续保险，在初始 ICD9/10 代码诊断后有 BCS 或乳房切除术的证据。逻辑回归和分位数多变量回归模型分别评估了临床和非临床因素与 BCS 结局和手术时间之间的关系。
本研究共纳入了 53060 名女性。与乳房切除术相比，BCS 与年龄较大（ORs：1.54 至 2.99，95%CI 1.45 至 3.38；p<0.0001）和更高的社区医疗遗传学（OR：5.88，95%CI 1.38 至 25.00；p=0.02）或妇产科（OR：1.13，95%CI 1.02 至 1.25；p=0.02）医生密度显著相关。BCS 时间较短与居住在南部（-2.96，95%CI -4.39 至 -1.33；p<0.0001）有关。BCS 时间较长与居住在更城市化（4.18，95%CI 0.08 至 8.29；p=0.05）、教育程度更高（9.02，95%CI 0.13 至 17.91；p=0.05）或整形外科医生密度较高（4.62，95%CI 0.50 至 8.73；p=0.03）的社区有关。
临床和非临床因素与 BCS 的采用和治疗时间有关，这表明有机会确保公平和及时的护理。
