Importance Compared with non-Hispanic white women, racial/ethnic minority women receive a diagnosis of breast cancer at a more advanced stage and have higher morbidity and mortality with breast cancer diagnosis. Access to care with adequate insurance may be associated with earlier diagnosis, expedited treatment, and improved prognosis. Objective To examine the extent to which insurance is associated with access to timely breast cancer diagnosis and breast cancer stage differences among a large, diverse population of US patients with breast cancer. Design, Setting, and Participants This retrospective, cross-sectional population-based study used data from the Surveillance, Epidemiology, and End Results Program on 177 075 women aged 40 to 64 years who received a diagnosis of stage I to III breast cancer between January 1, 2010, and December 31, 2016. Statistical analysis was performed from August 1, 2017, to October 1, 2019. Main Outcomes and Measures The primary outcome was the risk of having a more advanced stage of breast cancer at diagnosis (ie, stage III vs stages I and II). Mediation analyses were conducted to determine associations of race/ethnicity and proportion of observed differences mediated by health insurance status with earlier stage of diagnosis. Results A total of 177 075 women (mean [SD] age, 53.5 [6.8] years; 148 124 insured and 28 951 uninsured or receiving Medicaid) were included in the study. A higher proportion of women either receiving Medicaid or who were uninsured received a diagnosis of locally advanced breast cancer (stage III) compared with women with health insurance (20% vs 11%). In multivariable models, non-Hispanic black (odds ratio [OR], 1.46 [95% CI, 1.40-1.53]), American Indian or Alaskan Native (OR, 1.31 [95% CI, 1.07-1.61]) and Hispanic (OR, 1.35 [95% CI, 1.30-1.42]) women had higher odds of receiving a diagnosis of locally advanced disease (stage III) compared with non-Hispanic white women. When adjusting for health insurance and other socioeconomic factors, associations between race/ethnicity and risk of locally advanced breast cancer were attenuated (non-Hispanic black: OR, 1.29 [95% CI, 1.23-1.35]; American Indian or Alaskan Native: OR, 1.11 [95% CI, 0.91-1.35]; Hispanic: OR, 1.17 [95% CI, 1.12-1.22]). Nearly half (45%-47%) of racial differences in the risk of locally advanced disease were mediated by health insurance. Conclusions and Relevance This study's findings suggest that nearly half of the observed racial/ethnic disparities in higher stage at breast cancer diagnosis are mediated by health insurance coverage.

中文翻译：

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保险状况和种族差异与早期乳腺癌检测的关联。

重要性与非西班牙裔白人妇女相比，种族/少数族裔妇女在更晚期接受乳腺癌的诊断，并在乳腺癌诊断中具有更高的发病率和死亡率。获得足够保险的护理可能与早期诊断，加快治疗和改善预后有关。目的探讨保险的程度与美国众多不同乳腺癌患者群体中及时获得乳腺癌诊断和乳腺癌分期差异相关。设计，背景和参与者这项回顾性，横断面，基于人群的研究使用了来自监测，流行病学和最终结果计划的数据，研究对象是177075名40至64岁的女性，这些女性在一月份之间被诊断为I至III期乳腺癌。 2010年1月1日和12月31日，2016年。从2017年8月1日至2019年10月1日进行统计分析。主要结果和措施主要结果是诊断出患有更晚期乳腺癌的风险（即III期与I和II期相比） 。进行了调解分析，以确定种族/种族和健康保险状况与早期诊断所介导的观察到差异的比例之间的联系。结果研究共纳入177 075名妇女（平均[SD]年龄，53.5 [6.8]岁； 148 124名保险人和28 951名未保险或接受医疗补助的妇女）。与有医疗保险的妇女相比，接受医疗补助或未投保的妇女被诊断出患有局部晚期乳腺癌（第三阶段）的比例更高（20％比11％）。在多变量模型中，非西班牙裔黑人（赔率[OR]，1.46 [95％CI，1.40-1.53​​]），美洲印第安人或阿拉斯加土著（OR，1.31 [95％CI，1.07-1.61]）和西班牙裔（OR，1.35 [95％CI，1.30-1.42]）女性被诊断为与非西班牙裔白人女性相比，局部晚期疾病（III期）。在调整健康保险和其他社会经济因素时，种族/种族与局部晚期乳腺癌风险之间的关联性减弱了（非西班牙裔黑人：OR，1.29 [95％CI，1.23-1.35]；美洲印第安人或阿拉斯加土著人：OR ，1.11 [95％CI，0.91-1.35]；西班牙裔：OR，1.17 [95％CI，1.12-1.22]）。局部晚期疾病风险中种族差异的近一半（45％-47％）是由健康保险介导的。结论与相关性