title: Race/ethnicity and socio-economic differences in breast cancer surgery outcomes.
abstract: BACKGROUND
  The purpose of this study is to evaluate racial and socio-economic differences in breast cancer surgery treatment, post-surgical complications, hospital length of stay and mortality among hospitalized breast cancer patients.
  
  
  METHODS
  We examined the association between race/ethnicity and socio-economic status with treatment and outcomes after surgery among 71,156 women hospitalized with a primary diagnosis of breast cancer using the Nationwide Inpatient Sample database from 2007 to 2011. Multivariable regression models were used to compute estimates, odds ratios and 95% confidence intervals adjusting for age, comorbidities, stage at diagnosis, insurance, and residential region.
  
  
  RESULTS
  Black women were more likely to receive breast conserving surgery but less likely to receive mastectomies compared with white women. They also experienced significantly longer hospital stays (β=0.31, 95% CI: 0.24, 0.39), post-surgical complications (OR=1.21, 95% CI: 1.04-1.42) and in-hospital mortality (OR=1.26, 95% CI: 1.07-1.50) compared with Whites, after adjusting for other factors including the number of comorbidities and treatment type.
  
  
  CONCLUSIONS
  Among patients hospitalized for breast cancer, there were racial differences observed in treatment and outcomes. Further studies are needed to fully characterize whether these differences are due to individual, provider level or hospital level factors, and to highlight areas for targeted approaches to eliminate these disparities.
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham AL, United States. Electronic address: tomiakin@uab.edu.
authors.forename: Tomi F
authors.initials: TF
authors.lastname: Akinyemiju
authors.affiliation: Rocky Mountain Cancer Rehabilitation Institute, School of Sport and Exercise Science, University of Northern Colorado, Greeley, CO, United States.
authors.forename: Neomi
authors.initials: N
authors.lastname: Vin-Raviv
authors.affiliation: Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham AL, United States.
authors.forename: Daniel
authors.initials: D
authors.lastname: Chavez-Yenter
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham AL, United States.
authors.forename: Xueyan
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham AL, United States.
authors.forename: Henna
authors.initials: H
authors.lastname: Budhwani
mesh_terms: D001741:Black or African American; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D015897:Comorbidity; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008875:Middle Aged; D012923:Social Class; D044465:White People
keywords: Breast cancer; Disparities; Mortality; Race/ethnicity; Socio-economic status; Surgery