title: Racial disparities in individual breast cancer outcomes by hormone-receptor subtype, area-level socio-economic status and healthcare resources.
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.
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA. tomiakin@uab.edu.|Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA. tomiakin@uab.edu.
authors.forename: Tomi
authors.initials: T
authors.lastname: Akinyemiju
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.|Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Justin Xavier
authors.identifier: 0000-0002-5496-752X
authors.initials: JX
authors.lastname: Moore
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.|Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.|HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA.
authors.forename: Akinyemi I
authors.initials: AI
authors.lastname: Ojesina
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.|Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Waterbor
authors.affiliation: Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
authors.forename: Sean F
authors.initials: SF
authors.lastname: Altekruse
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000208:ethnology / Q000378:metabolism / Q000401:mortality* / Q000473:pathology*; D005260:Female; D000069576:Health Equity; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology*; D006630:Hispanic or Latino; D006801:Humans; D008875:Middle Aged; D011960:Receptors, Estrogen / Q000378:metabolism*; D011980:Receptors, Progesterone / Q000378:metabolism*; D018426:SEER Program; D012959:Socioeconomic Factors; D044465:White People
chemical_list: D011960:Receptors, Estrogen; D011980:Receptors, Progesterone
keywords: Breast cancer outcomes; Healthcare access; Hormone-receptor subtype; Racial disparities; Socio-economic status