Abstract B127: Hispanic-White residential segregation and stage at diagnosis among female residents of Texas

Abstract

Abstract Background: Breast cancer is the second leading cause of cancer-related deaths among females in the United States. Individual and neighborhood-level characteristics have been associated with breast cancer-related disparities. There is a paucity of literature about Hispanic-White residential segregation and stage at diagnosis of breast cancer, and whether residential segregation explains or moderates disparities in stage at diagnosis among Hispanics. Objectives: To explore whether Hispanic-White residential segregation is associated with late-stage breast cancer, and how it explains or moderates disparities in stage at diagnosis of breast cancer associated with Hispanic ethnicity. To explore whether health insurance coverage and census tract (CT) poverty level explains or moderates disparities associated with residential segregation. Methods: This is a retrospective data analysis using the Texas Cancer Registry. The analyses were restricted to non-Hispanic White and Hispanic females ages 18 and older diagnosed with breast cancer from 2007-2014, and who had only one primary tumor. The dependent variable was stage at diagnosis (early, late). The independent variables of interest were Hispanic-White residential segregation, race/ethnicity, type of insurance coverage and CT poverty level. Multilevel logistic regression models with individuals nested within CT were used for analyses. The final sample size was 80,149 individuals nested within 5,023 CT. Results: Hispanics were more likely to be diagnosed with late-stage breast cancer (OR=1.14; 95% CI=1.10-1.19). Increasing Hispanic-White residential segregation was associated with increased likelihood of late-stage diagnosis (OR=1.46; 95% CI=1.04-2.05). Type of health insurance explained some of the association between residential segregation and late-stage diagnosis. Residential segregation did not explain or moderate the association between Hispanic ethnicity and breast cancer stage at diagnosis. Predicted probability estimates showed that individuals who were uninsured or insured through Medicaid had similar probabilities of late-stage diagnosis. These disparities were worse for uninsured or Medicaid-insured Hispanic residents of highly segregated CTs. Conclusion: Hispanic-White residential segregation was associated with increased likelihood of late-stage breast cancer diagnosis. Interventions to increase early-stage breast cancer diagnosis are needed among residents of CTs with high residential segregation, especially among Medicaid insured and uninsured women. Interventions aimed at raising awareness of the association between Hispanic residential segregation and breast cancer stage at diagnosis among healthcare providers should be explored. Citation Format: Chinedum Ojinnaka. Hispanic-White residential segregation and stage at diagnosis among female residents of Texas [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B127.