The Article: Schootman, M., Jeffe, D., Lian, M., Deshpande, A., Gillanders, W., Aft, R., & Sumner, W. (2008). Area-Level poverty is associated with greater risk of ambulatory-care-sensitive hospitalizations in older breast cancer survivors. Journal of the American Geriatrics Society, 56: 2180-2187.

Big Idea: The authors used the 1992 to 1999 National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program data to see if more than 47,000 breast cancer survivors age 66 and older living in census tracks with higher poverty rates were more likely to be hospitalized than their counterparts living in lower-poverty census tracks. Authors tracked hospitalizations, characterized as ambulatory-care-sensitive hospitalizations, or ACSH – via Medicare claims files. These hospitalizations could have been prevented with adequate symptom management, follow-up, and preventive care.

Survey Says!: 13.3% of the study sample had at least one ACSH during the study period. Older breast cancer survivors living in higher poverty census tracks had 1.5 times as many ACSH’s as older breast cancer survivors residing in lower poverty census tracks.

Quotable: “An emerging body of literature shows that women residing in areas with higher poverty rates have worst breast cancer-related outcomes, including more late-stage disease and poorer survival, possibly due to suboptimal screening, diagnostic follow-up, and treatment [references]” (p. 2181).

“This study confirms prior ecological studies of ACSH in the general population that showed that greater poverty rate is associated with more ACSH [references]. However, this study went beyond these ecological studies by using a prospective, multilevel design, thereby providing additional evidence for a possible relationship between census-track poverty rate and ACSH in addition to the confounding influence of individual-level factors, particularly in the growing population of women with breast cancer” (p. 2185).

So What?: ACSH’s are indicative of a healthcare system breakdown either in access to care or care processes. They are completely preventable; yet, we are failing many women in our communities, particularly higher-poverty areas. Stronger primary care and outpatient services, including patient navigation and multidisciplinary care teams, may provide support to reduce ACSH’s among older breast cancer survivors in high-poverty areas.