Graduation Year

2005

Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

Health Policy and Management

Major Professor

Dr. James Studnicki.

Keywords

Insurance, Health access, Women's health, Lumpectomy, Rurality

Abstract

This study explores the relationship between race and surgical treatment and radiation therapy use for localized breast cancer patients in the state of Florida in 2001. The study will be useful in raising awareness of the relationship between Black race and appropriate breast cancer treatment within the Florida Cancer Data System. The Healthy People 2010 initiatives call to eliminate racial disparities and the high placement of breast cancer on the national research agenda make this study timely and insightful for health policymakers, clinicians and other health researchers.

Also, the study evaluates the effect of other health system and patient related factors such as insurance provider and rural versus urban residence, to the appropriate use of cancer therapy in order to present an up-to-date and accurate picture of the quality of breast cancer care for women in the state of Florida.The study used multivariate logistic regression modeling and chi-square distribution to compare models in order to disentangle the effects of age, rural residence, marital status and primary health insurance provider from race and to determine how these factors influenced breast conserving surgery versus mastectomy use.

Further, the second research question exclusively focused on the population that received breast conserving surgery in order to examine the impact of race and the other covariates as explanatory measures of appropriate receipt of radiation therapy.The first hypothesis found that there was no statistically significant difference between Black and White women in terms of receipt of breast conserving surgery for treatment of localized breast cancer. The second hypothesis, which focused on appropriate receipt of radiation therapy following breast conserving surgery, found that there was a statistically significant interaction between Black race and Medicaid as primary health insurance provider.The study concludes by examining possible areas of improvement in data collection in the State of Florida.

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