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Purpose: Population-based studies have revealed higher mortality among breast cancer patients treated in low-volume hospitals. Other studies have demonstrated disparities in race and socioeconomic status (SES) in breast cancer survival. The purpose of our study was to determine whether nonwhite or low-SES patients are disproportionately treated in low-volume hospitals., Methods: A population-based cohort of 2,777 Medicare breast cancer patients who underwent breast cancer surgery in 2003 participated in a survey study examining breast cancer outcomes. Information was obtained from survey responses, Medicare claims, and state tumor registry data., Results: On univariate analysis, patients treated at low-volume hospitals were less likely to be white, less likely to live in an urban location, and more likely to have a low SES with less social support and live a greater distance from a high-volume hospital. Education, marital status, total household income, having additional insurance besides Medicare, population density of primary residence, and tangible support were associated with distance to the nearest high-volume hospital. On multivariate analysis, the independent predictors of treatment at a low-volume hospital were being nonwhite (P = 0.003), having a lower household income (P < 0.0001), residence in a rural location (P = 0.01), and living a greater distance from a high-volume hospital (P < 0.0001)., Conclusions: In this large population-based cohort, women who were poorer, nonwhite, and who lived in a rural location or at a greater distance from a high-volume hospital were more likely to be treated at low-volume hospitals. These differences may partially explain racial and SES disparities in breast cancer outcomes.

Background: Colorectal cancer is the third most common cancer in the United States, but the rate of screening remains low. Since 2001, Medicare has provided coverage of colonoscopy for colorectal cancer screening in individuals at average risk, but little is known about the effect of this coverage on screening or disparities in screening practices., Methods: We examined the Medicare physician/supplier billing claims file for New York, Florida, and Illinois for the years 2002 and 2003. Using a previously employed algorithm, we identified the rates of colorectal screening tests in individuals at average risk. We performed multivariate logistic regression analysis to calculate the effects of sex, racial/ethnic, and socioeconomic characteristics on screening. We also looked for interactions between socioeconomic and demographic variables., Results: A total of 596 470 Medicare beneficiaries were included in the study. Approximately 18.3% of the population had undergone a screening colon test during the study period. Nonwhite persons were less likely to be screened for colorectal cancer than were white persons (relative risk [RR], 0.52; 95% confidence interval [CI], 0.50-0.53). The lowest RR of screening colonoscopy in women compared with men was in the oldest age group and the highest income tertile (RR for whites, 0.64; 95% CI, 0.59-0.70). Higher income level was associated with screening colonoscopy in white patients (men: RR, 1.19; 95% CI, 1.14-1.25; women: RR, 1.09; 95% CI, 1.05-1.15) but not in nonwhite patients (men: RR, 0.97; 95% CI, 0.78-1.22; women: RR, 0.94; 95% CI, 0.78-1.14)., Conclusion: Despite the expansion of Medicare coverage for colorectal cancer screening, there still remain significant disparities between sex and racial/ethnic groups in screening practices.