Breast Cancer Survival Disparities in Mexican Women Under a Comprehensive Health Reform

Abstract

PURPOSE One of the goals of Seguro Popular, Mexico’s landmark healthcare reform, was bridging the existing disparities in access to health care and health status. In 2007, this program began reimbursement of breast cancer treatment of previously uninsured Mexican women. We evaluated geographic disparities in breast cancer survival in women treated under this program and explored potential sources of heterogeneity. METHODS We classified women who were treated between 2007 and 2016 as having early (stages 0-IIA), locally advanced (stages IIB-IIIC), or metastatic (stage IV) disease. We categorized women based on a widely used marginalization index that considers education, household characteristics, rural population, and poverty levels in Mexican municipalities (low, moderate, high, and very high marginalization). We cross-linked reimbursement data with a national death registry and estimated 5-year overall survival according to clinical stage, marginalization levels, and state where women received treated. RESULTS Among 53,990 women treated for breast cancer the mean age was 52.9 years (± SD 12.4). Most patients had locally advanced disease (57.4%, n = 30,996). Early disease was more common in women with very low marginalization levels compared with women with very high levels (34% v 19%). Survival was 89.4% (95% CI: 88.8 to 89.9) for early disease, 69.8% (95% CI: 69.2 to 70.4) for locally advanced disease, and 36.1% (95% CI: 34.6 to 37.6) for metastatic disease. The least marginalized state experienced the highest survival for locally-advanced disease [76.0% (95% CI: 71.4 to 80.0)] whereas the most marginalized state experienced the lowest survival [50.2% (95% CI: 45.5 to 54.7)]. Survival in women from very highly marginalized communities was 68.7% (95% CI: 64.7 to 72.4), whereas survival in women from low marginalized communities was 74.8% (95% CI: 74.1 to 75.5). CONCLUSION In the face of a new wave of healthcare reform, Mexico will need to monitor and evaluate health disparities to achieve universal care for women with breast cancer.