Abstract P5-12-03: Racial differences in breast cancer survival in a large urban integrated health system

Abstract

Abstract Background: Despite improvements in breast cancer outcomes, there continues to be a large gap in survival between African American (AA) and White women with breast cancer, which may be due at least in part to racial differences in access to care. In order to better understand breast cancer survival disparities, we evaluated factors that predict racial differences in survival among women treated at a large integrated health care system in Southeastern Michigan. Materials and Methods: The study population included 2,387 women (34% AA) with stage I through III breast cancer treated at the Henry Ford Health System (HFHS) from 1996 through 2005. Linked datasets from the HFHS, the Metropolitan Detroit Cancer Surveillance System (MDCSS) and the U.S. Census Bureau were used to obtain socio-demographic and clinical information. Co-morbidity was assessed by the Charlson co-morbidity index (CCI), and economic deprivation was categorized into 5 quintiles of increasingly worse socioeconomic deprivation, using a census tract deprivation index (DI). Results: AA women were significantly more likely than Whites to have larger (41% vs. 32% > 2 cm) and hormone receptor (HR) negative tumors (30% vs 19%), to have a higher CCI (15% vs 9% > 2) and to reside in a more economically deprived area (46% vs. 5% residing in quintile 5). Unadjusted analysis showed that AA had a significantly higher risk of death than White women (hazards ratio [HR], 1.36, 95% confidence interval [CI], 1.16-1.59). After multivariable adjustment for clinical (age, stage, HR and CCI), and societal factors (insurance, DI), race was no longer significantly associated with overall survival, HR, 1.12, 95% CI, 0.94-1.33, p = 0.22, and 1.02, 95% CI 0.83-1.24, p = 0.88, respectively. Stratified analyses by DI showed no racial difference in survival for each of 5 levels of DI. Discussion: In a large urban integrated health care system, racial differences in breast cancer survival appear to be related to clinical and socioeconomic characteristics. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-12-03.