Geographic Variations and the Associated Factors in Adherence to and Persistence with Adjuvant Hormonal Therapy for the Privately Insured women Aged 18-64 with Breast Cancer in Texas

被引:0
作者
Kim, Junghyun [1 ]
Kim, Man S. [2 ]
Rajan, Suja S. [3 ]
Du, Xianglin L. [4 ]
Franzini, Luisa [5 ]
Kim, Tae Gi [6 ]
Giordano, Sharon H. [7 ]
Morgan, Robert O. [3 ]
机构
[1] Yonsei Univ, Coll Med, Dept Prevent Med, Seoul 03722, South Korea
[2] Kyung Hee Univ, Kyung Hee Univ Hosp Gangdong, Clin Res Inst, Sch Med, Seoul 05278, South Korea
[3] Univ Texas Hlth Sci Ctr Houston, Sch Publ Hlth, Dept Management Policy & Community Hlth, Houston, TX 77030 USA
[4] Univ Texas Hlth Sci Ctr Houston, Sch Publ Hlth, Dept Epidemiol Human Genet & Environm Sci, Houston, TX 77030 USA
[5] Univ Maryland, Sch Publ Hlth, Dept Hlth Serv Adm, College Pk, MD 20742 USA
[6] Kyung Hee Univ, Kyung Hee Univ Hosp Gangdong, Dept Ophthalmol, Coll Med, Seoul 05278, South Korea
[7] Univ Texas MD Anderson Canc Ctr, Dept Hlth Serv Res, Houston, TX 77030 USA
基金
新加坡国家研究基金会;
关键词
geographic variation; adjuvant hormonal therapy; breast cancer; adherence; persistence; REGIONAL-VARIATION; ENDOCRINE THERAPY; MEDICATION ADHERENCE; COMORBIDITY INDEX; PHARMACY RECORDS; OLDER WOMEN; TAMOXIFEN; NONADHERENCE; POPULATION; PREDICTORS;
D O I
10.3390/curroncol30040288
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
The purpose of this study is to examine the geographical patterns of adjuvant hormonal therapy adherence and persistence and the associated factors in insured Texan women aged 18-64 with early breast cancer. A retrospective cohort study was conducted using 5-year claims data for the population insured by the Blue Cross Blue Shield of Texas (BCBSTX). Women diagnosed with early breast cancer who were taking tamoxifen or aromatase inhibitors (AIs) for adjuvant hormonal therapy with at least one prescription claim were identified. Adherence to adjuvant hormonal therapy and persistence with adjuvant hormonal therapy were calculated as outcome measures. Women without a gap between two consecutively dispensed prescriptions of at least 90 days were considered to be persistently taking the medications. Patient-level multivariate logistic regression models with repeated regional-level adjustments and a Cox proportional hazards model with mixed effects were used to determine the geographical variations and patient-, provider-, and area-level factors that were associated with adjuvant hormonal therapy adherence and persistence. Of the 938 women in the cohort, 627 (66.8%) initiated adjuvant hormonal therapy. Most of the smaller HRRs have significantly higher or lower rates of treatment adherence and persistence rates relative to the median regions. The use of AHT varies substantially from one geographical area to another, especially for adherence, with an approximately two-fold difference between the lowest and highest areas, and area-level factors were found to be significantly associated with the compliance of AHT. There are geographical variations in AHT adherence and persistence in Texas. Patient-level and area-level factors have significant associations explaining these patterns.
引用
收藏
页码:3800 / 3816
页数:17
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