Comparing Stage at Diagnosis among Patients Served by Military and Civilian Medical Care Systems.

摘要

Breast cancer remains one of the top causes of cancer-related deaths in women in the United States, and little is known about differences in access to health care between military and civilians. This study compared differences of access to health care between military and civilian patients with female breast cancer. In particular, this study examined whether BC patients, in an equal access health care system such as the military, get diagnosed at an earlier stage of disease process in comparison to the BC patients in the civilian health care system. The study used the cancer staging theory as a conceptual framework and was based on differences in access to health care. The independent variables included military versus civilian care and demographic variables, while the stage of cancer at diagnosis was the dependent variable. This cross-sectional study of two groups included data from 2198 women with BC (439 military and 1759 civilian) for years 2004 through 2008. Chi-square and multiple logistic regression were used to analyze the data. There was no difference between the early BC stage (0, I, II) diagnosis prevalence rate in the military vs. the civilian group). The logistic regression (full model) was statistically significant and indicated that the military and civilian health systems had equal performance on the stage at diagnosis indicator. Blacks had statistically higher odds (2.43) than whites of being in the late stage BC group at diagnosis. This further confirms the existence of racial disparities in access to care among BC patients in civilian and military health systems. This research encourages social change by identifying specific, contributing factors and may lead to development of health promotion programs designed to increase earlier BC screening among African Americans in both health systems.