TY - JOUR
T1 - Early diffusion of gene expression profiling in breast cancer patients associated with areas of high income inequality
AU - Ponce, Ninez A.
AU - Ko, Michelle J
AU - Liang, Su Ying
AU - Armstrong, Joanne
AU - Toscano, Michele
AU - Chanfreau-Coffinier, Catherine
AU - Haas, Jennifer S.
PY - 2015
Y1 - 2015
N2 - With the Affordable Care Act reducing coverage disparities, social factors could prominently determine where and for whom innovations first diffuse in health care markets. Gene expression profiling is a potentially cost-effective innovation that guides chemotherapy decisions in early-stage breast cancer, but adoption has been uneven across the United States. Using a sample of commercially insured women, we evaluated whether income inequality in metropolitan areas was associated with receipt of gene expression profiling during its initial diffusion in 2006-07. In areas with high income inequality, gene expression profiling receipt was higher than elsewhere, but it was associated with a 10.6-percentage-point gap between high- and lowincome women. In areas with low rates of income inequality, gene expression profiling receipt was lower, with no significant differences by income. Even among insured women, income inequality may indirectly shape diffusion of gene expression profiling, with benefits accruing to the highest-income patients in the most unequal places. Policies reducing gene expression profiling disparities should address low-inequality areas and, in unequal places, practice settings serving low-income patients.
AB - With the Affordable Care Act reducing coverage disparities, social factors could prominently determine where and for whom innovations first diffuse in health care markets. Gene expression profiling is a potentially cost-effective innovation that guides chemotherapy decisions in early-stage breast cancer, but adoption has been uneven across the United States. Using a sample of commercially insured women, we evaluated whether income inequality in metropolitan areas was associated with receipt of gene expression profiling during its initial diffusion in 2006-07. In areas with high income inequality, gene expression profiling receipt was higher than elsewhere, but it was associated with a 10.6-percentage-point gap between high- and lowincome women. In areas with low rates of income inequality, gene expression profiling receipt was lower, with no significant differences by income. Even among insured women, income inequality may indirectly shape diffusion of gene expression profiling, with benefits accruing to the highest-income patients in the most unequal places. Policies reducing gene expression profiling disparities should address low-inequality areas and, in unequal places, practice settings serving low-income patients.
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U2 - 10.1377/hlthaff.2014.1013
DO - 10.1377/hlthaff.2014.1013
M3 - Article
C2 - 25847643
AN - SCOPUS:84929625179
VL - 34
SP - 609
EP - 615
JO - Health Affairs
JF - Health Affairs
SN - 0278-2715
IS - 4
ER -