Socioeconomic and Racial Disparities in Cancer Stage at Diagnosis, Tumor Size, and Clinical Outcomes in a Large Cohort o
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Socioeconomic and Racial Disparities in Cancer Stage at Diagnosis, Tumor Size, and Clinical Outcomes in a Large Cohort of Women with Breast Cancer, 2007–2016 Dale Hardy 1 & Daniel Y. Du 2 Received: 7 April 2020 / Revised: 19 August 2020 / Accepted: 24 August 2020 # W. Montague Cobb-NMA Health Institute 2020
Abstract Background Socioeconomic and treatment factors contribute to diagnosis of early-stage (local-stage) breast cancer, as well as excess deaths among African American women. Objectives We evaluated socioeconomic and treatment predictive factors for early-stage breast cancer among African American women compared to Caucasian women. A secondary aim evaluated predictors and overall risks associated with all-cause and breast cancer–specific mortality. Methods We used retrospective cohort population-based study data from the Surveillance, Epidemiology, and End Results (SEER) Program on 547,703 women aged ≥ 20 years diagnosed with breast cancer primary tumors from 2007 to 2016. Statistical analysis used logistic regression to assess predictors of early-stage breast cancer and Cox proportional hazards regression for mortality risks. Results African American women were more likely to be diagnosed at advanced-stage, had larger tumor size at diagnosis, and received less cancer-directed surgery, but more chemotherapy than Caucasian women. Insured women (> 50%) were more likely to be diagnosed at early-stage and to have smaller tumors (p < 0.05). Education level, poverty level, and household income had no impact on racial disparities or socioeconomic disparities in women diagnosed at early stage. We found increased risks for allcause mortality (hazard ratio = 1.18; 95% confidence interval, 1.16–1.21) and breast cancer–specific mortality (HR = 1.22; 95% CI, 1.19–1.25) among African American women compared to Caucasian women after adjusting for demographic, socioeconomic, and treatment factors. Conclusions In this population-based study using the most recent SEER data, African American women with breast cancer continued to exhibit higher all-cause mortality and breast cancer–specific mortality compared to Caucasian women. Keywords Breast cancer . Early stage . Racial disparities . Treatment . Surgery . Chemotherapy . Race/ethnicity . African American women
Introduction Despite continual efforts to reduce the burden of inequalities in socioeconomic levels and among ethnic minority races compared to Caucasians, disparities in health care utilization * Dale Hardy [email protected] 1
Department of Internal Medicine, Morehouse School of Medicine, Research Wing, Rm 339, 720 Westview Drive, Atlanta, GA 30310, USA
2
Department of Natural Sciences, University of Houston, Houston, TX 77030, USA
and clinical outcomes continue to persist [1–11]. Reports by the Institute of Medicine [1] and other studies [2–11] have consistently demonstrated disparities observed in cancer care and treatment among ethnic minority populations compared to Caucasians. Although outcomes on racial disparities in cancer care utilization are relatively co
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