title: Mortality risk from comorbidities independent of triple-negative breast cancer status: NCI-SEER-based cohort analysis.
abstract: OBJECTIVE
  A comparatively high prevalence of comorbidities among African-American/Blacks (AA/B) has been implicated in disparate survival in breast cancer. There is a scarcity of data, however, if this effect persists when accounting for the adverse triple-negative breast cancer (TNBC) subtype which occurs at threefold the rate in AA/B compared to white breast cancer patients.
  
  
  METHODS
  We reviewed charts of 214 white and 202 AA/B breast cancer patients in the NCI-SEER Connecticut Tumor Registry who were diagnosed in 2000-2007. We employed the Charlson Co-Morbidity Index (CCI), a weighted 17-item tool to predict risk of death in cancer populations. Cox survival analyses estimated hazard ratios (HRs) for all-cause mortality in relation to TNBC and CCI adjusting for clinicopathological factors.
  
  
  RESULTS
  Among patients with SEER local stage, TNBC increased the risk of death (HR 2.18, 95 % CI 1.14-4.16), which was attenuated when the CCI score was added to the model (Adj. HR 1.50, 95 % CI 0.74-3.01). Conversely, the adverse impact of the CCI score persisted when controlling for TNBC (Adj. HR 1.49, 95 % CI 1.29-1.71; per one point increase). Similar patterns were observed in SEER regional stage, but estimated HRs were lower. AA/B patients with a CCI score of ≥3 had a significantly higher risk of death compared to AA/B patients without comorbidities (Adj. HR 5.65, 95 % CI 2.90-11.02). A lower and nonsignificant effect was observed for whites with a CCI of ≥3 (Adj. HR 1.90, 95 % CI 0.68-5.29).
  
  
  CONCLUSIONS
  comorbidities at diagnosis increase risk of death independent of TNBC, and AA/B patients may be disproportionately at risk.
authors.affiliation: Department of Community Medicine and Health Care, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA. swede@uchc.edu.
authors.forename: Helen
authors.initials: H
authors.lastname: Swede
authors.affiliation: Department of Community Medicine and Health Care, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA.
authors.forename: Amna
authors.initials: A
authors.lastname: Sarwar
authors.affiliation: Department of Community Medicine and Health Care, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA.
authors.forename: Anil
authors.initials: A
authors.lastname: Magge
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Dejana
authors.initials: D
authors.lastname: Braithwaite
authors.affiliation: Department of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico, Albuquerque, NM, USA.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Cook
authors.affiliation: Department of Community Medicine and Health Care, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA.
authors.forename: David I
authors.initials: DI
authors.lastname: Gregorio
authors.affiliation: Yale School of Public Health, New Haven, CT, USA.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Jones
authors.affiliation: Department of Community Medicine and Health Care, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: R Hoag
authors.affiliation: Connecticut Tumor Registry, Connecticut Department of Public Health, Hartford, CT, USA.
authors.forename: Lou
authors.initials: L
authors.lastname: Gonsalves
authors.affiliation: Helen & Harry Gray Cancer Center, Hartford Hospital, Hartford HealthCare System, Hartford, CT, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: L Salner
authors.affiliation: The Hospital of Central Connecticut, Hartford HealthCare System, Hartford, CT, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Zarfos
authors.affiliation: New England Sickle Cell Institute, Department of Medicine and Neag Cancer Center, University of Connecticut Health, Farmington, CT, USA.
authors.forename: Biree
authors.initials: B
authors.lastname: Andemariam
authors.affiliation: Department of Community Medicine and Health Care, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Stevens
authors.affiliation: New England Sickle Cell Institute, Department of Medicine and Neag Cancer Center, University of Connecticut Health, Farmington, CT, USA.
authors.forename: Alicia
authors.initials: A
authors.lastname: G Dugan
authors.affiliation: Department of Occupational and Environmental Medicine, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Mellisa
authors.initials: M
authors.lastname: Pensa
authors.affiliation: Department of Community Medicine and Health Care, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: A Brockmeyer
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D003237:Connecticut / Q000453:epidemiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis; D064726:Triple Negative Breast Neoplasms / Q000401:mortality*; D044465:White People
keywords: Breast cancer; Cancer survival disparity; Charlson Co-Morbidity Index; Co-morbidity; TNBC