Abstract B095: Association of race and neighborhood deprivation with early-stage breast cancer survival in the United States

Abstract

Abstract Introduction: Socioeconomic status (SES) of individuals and their neighborhoods holds significant influence over their access to the healthcare system and consequently, the outcomes of their diseases. Inequities in opportunities, education, income, and developmental infrastructure can contribute to poor prognosis and unfavorable outcomes for breast cancer (BC) in areas with lower SES. We studied the association of race and ethnicity with the neighborhood deprivation index (NDI) and the survival of early-stage BC. Methodology We utilized the NDI quintile (qn) developed by the National Cancer Institute, which incorporates variables from dimensions such as wealth and income, education, occupation, and housing conditions. By querying the SEER database from 2010 to 2016, we identified early-stage BC patients (pts) and examined the association between NDI, race/ethnicity and overall survival (OS) and disease-specific survival (DSS). Cox multivariate regression was employed to assess the association between NDI and OS/DSS. Kruskal-Wallis test, and chi-square tests were used for comparisons of continuous, categorical variables respectively. All analyses were adjusted for age, race, grade, insurance, and treatments. Statistical analyses were performed using SAS. Results Out of the 88,572 early-stage BC pts, 27.4 % (n= 24,307) were in the most deprivation (MD) qn, 26.5% (n= 23,447) were in the average deprivation (AD) qn, 17% (n= 15,035) were in the above average deprivation (AA) qn, 15.6% (n= 13,838) were in the least deprivation (LD) qn and 13.5% (n= 11,945) were in the below average deprivation (BA) qn. There was a predominance of racial minorities in the MD and AA qn with Blacks being 13-15% and Hispanics being 15% compared to only 8% Blacks and 6% Hispanics in the LD qn (p<0.001). There was a higher percentage of uninsured pts in the MD qn compared to LD qn (2.2% vs 1.7%, p<0.001). The interaction between NDI and race for OS and DSS was significant (p-interaction 0.0030 and 0.02 respectively). In the multivariate analysis, Whites residing in the MD and AA qn had higher overall and disease-specific mortality compared to those residing in the LD qn (OS- MD: HR= 1.23, 95% CI= 1.14-1.34, p<0.001, AA: HR= 1.32, 95% CI= 1.21-1.44, p<0.001; DSS- MD: HR= 1.29, 95% CI= 1.15-1.45, p<0.001, AA: HR= 1.37, 95% CI= 1.21-1.56, p<0.001). However, this disparity in mortality based on the NDI was not observed for Blacks with early-stage BC (OS- MD: HR= 1.2, 95% CI= 0.98-1.46, p=0.06, AA: HR= 1.17, 95% CI= 0.95-1.44, p= 0.01, DSS- MD: HR= 1.2, 95% CI= 0.94-1.55, p= 0.12, AA: HR= 1.22, 95% CI= 0.94-1.6, p=0.11). Conclusion Blacks with early-stage BC have poor OS and DSS regardless of the SES of the neighborhoods. Personalized treatments are needed for Blacks with early-stage BC to improve their clinical outcomes. Whites living in areas with early-stage BC have poor OS and DSS. To reduce healthcare disparities and enhance breast cancer outcomes, targeted investments and policies should prioritize improving the SES of underprivileged areas with high deprivation. Citation Format: Arya Mariam Roy, Anthony George, Archit Patel, Kristopher Attwood, Shipra Gandhi. Association of race and neighborhood deprivation with early-stage breast cancer survival in the United States [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B095.