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Integrating access to care and tumor patterns by race and age in the Carolina Breast Cancer Study, 2008–2013

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Abstract

Purpose

Understanding breast cancer mortality disparities by race and age is complex due to disease heterogeneity, comorbid disease, and the range of factors influencing access to care. It is important to understand how these factors group together within patients.

Methods

We compared socioeconomic status (SES) and comorbidity factors in the Carolina Breast Cancer Study Phase 3 (CBCS3, 2008–2013) to those for North Carolina using the 2010 Behavioral Risk Factor Surveillance Study. In addition, we used latent class analysis of CBCS3 data to identify covariate patterns by SES/comorbidities, barriers to care, and tumor characteristics and examined their associations with race and age using multinomial logistic regression.

Results

Major SES and comorbidity patterns in CBCS3 participants were generally similar to patterns in the state. Latent classes were identified for SES/comorbidities, barriers to care, and tumor characteristics that varied by race and age. Compared to white women, black women had lower SES (odds ratio (OR)  6.3, 95% confidence interval (CI) 5.2, 7.8), more barriers to care (OR 5.6, 95% CI 3.9, 8.1) and several aggregated tumor aggressiveness features. Compared to older women, younger women had higher SES (OR 0.5, 95% CI 0.4, 0.6), more barriers to care (OR 2.1, 95% CI 1.6, 2.9) and aggregated tumor aggressiveness features.

Conclusions

CBCS3 is representative of North Carolina on comparable factors. Patterns of access to care and tumor characteristics are intertwined with race and age, suggesting that interventions to address disparities will need to target both access and biology.

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Acknowledgments

This work was supported by a Grant from the UNC Lineberger Comprehensive Cancer Center funded by the University Cancer Research Fund (LCCC2017T204), Susan G. Komen Graduate Training in Disparities Research, the National Cancer Institute of the National Institutes of Health (P50-CA58223, U01-CA179715, T32-CA057726), and the National Institute of Environmental Health Sciences of the National Institutes of Health (P30-ES010126).

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Authors and Affiliations

  1. Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Marc A. Emerson, Yvonne M. Golightly, Allison E. Aiello, Andrew F. Olshan & Melissa A. Troester

  2. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Xianming Tan, Katherine E. Reeder-Hayes, Andrew F. Olshan & H. Shelton Earp

  3. Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Xianming Tan

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  1. Marc A. Emerson
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Emerson, M.A., Golightly, Y.M., Tan, X. et al. Integrating access to care and tumor patterns by race and age in the Carolina Breast Cancer Study, 2008–2013. Cancer Causes Control 31, 221–230 (2020). https://doi.org/10.1007/s10552-019-01265-0

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