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Racial disparities in individual breast cancer outcomes by hormone-receptor subtype, area-level socio-economic status and healthcare resources

  • Epidemiology
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Abstract

The aim of the study is to determine the influence of area-level socio-economic status and healthcare access in addition to tumor hormone-receptor subtype on individual breast cancer stage, treatment, and mortality among Non-Hispanic (NH)-Black, NH-White, and Hispanic US adults. Analysis was based on 456,217 breast cancer patients in the SEER database from 2000 to 2010. Multilevel and multivariable-adjusted logistic and Cox proportional hazards regression analysis was conducted to account for clustering by SEER registry of diagnosis. NH-Black women had greater area-level access to healthcare resources compared with women of other races. For instance, the average numbers of oncology hospitals per million population in counties with NH-Black, NH-White, and Hispanic women were 8.1, 7.7, and 5.0 respectively; average numbers of medical doctors per million in counties with NH-Black, NH-White, and Hispanic women were 100.7, 854.0, and 866.3 respectively; and average number of Ob/Gyn in counties with NH-Black, NH-White, and Hispanic women was 155.6, 127.4, and 127.3, respectively (all p values <0.001). Regardless, NH-Black women (HR 1.39, 95 % CI 1.36–1.43) and Hispanic women (HR 1.05, 95 % CI 1.03–1.08) had significantly higher breast cancer mortality compared with NH-White women even after adjusting for hormone-receptor subtype, area-level socio-economic status, and area-level healthcare access. In addition, lower county-level socio-economic status and healthcare access measures were significantly and independently associated with stage at presentation, surgery, and radiation treatment as well as mortality after adjusting for age, race/ethnicity, and HR subtype. Although breast cancer HR subtype is a strong, important, and consistent predictor of breast cancer outcomes, we still observed significant and independent influences of area-level SES and HCA on breast cancer outcomes that deserve further study and may be critical to eliminating breast cancer outcome disparities.

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Acknowledgments

Dr. Akinyemiju was supported by Grant U54 CA118948 from the NIH. Mr. Moore was supported by Grant R25 CA47888 from the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.

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Authors and Affiliations

  1. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA

    Tomi Akinyemiju, Justin Xavier Moore, Akinyemi I. Ojesina & John W. Waterbor

  2. Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA

    Tomi Akinyemiju, Justin Xavier Moore, Akinyemi I. Ojesina & John W. Waterbor

  3. HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA

    Akinyemi I. Ojesina

  4. Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA

    Sean F. Altekruse

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  1. Tomi Akinyemiju
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Correspondence to Tomi Akinyemiju.

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Akinyemiju, T., Moore, J.X., Ojesina, A.I. et al. Racial disparities in individual breast cancer outcomes by hormone-receptor subtype, area-level socio-economic status and healthcare resources. Breast Cancer Res Treat 157, 575–586 (2016). https://doi.org/10.1007/s10549-016-3840-x

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