Abstract PO-193: Disparities in perceived healthcare discrimination among BRCA1/2-positive women from disadvantaged health populations

Abstract

Abstract Background: Women with BRCA1/2 mutations have different healthcare experiences in comparison with women without these mutations due to their increased risk of breast and/or ovarian cancers before the age of 70. These women live with an increased burden of healthcare costs, ongoing surveillance, and preventive surgeries. They are also impacted by cancer- and insurance-related discrimination. This analysis evaluated disparities in the association with experiencing healthcare discrimination by race/ethnicity, annual household income, and education among women with BRCA1/2 mutations. Methods: We conducted a cross-sectional study of US-based women (≥18 years) who tested positive for either (or both) BRCA1/2 genetic mutations within the past 5 years and who identify with one or more disadvantaged health population (racial, ethnic, or sexual minority, person with a physical disability, chronically ill, those in poverty, immigrant populations). A total of 211 women were recruited from Facebook BRCA1/2-oriented support groups to complete an online survey measuring demographic, cancer, and genetic information, in addition to experiences with access to care and genetic testing. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression models for the associations between race/ethnicity (non-Hispanic white (NHW), racial/ethnic minority), annual household income (at or above $40,000, below $40,000), education (college graduate, no college), and perceived experience of healthcare discrimination using the Discrimination in Medical Settings Scale responses. Models were adjusted for age at survey, years since genetic testing, out-of-pocket cost for genetic testing, comorbidities, marital status, income, disability status, cancer history, and residential locale. Results: A total of 182 women were included in the analysis, of which 57 were cancer survivors. Most participants were NHW (67.2%), <50 years of age (83.2%), and college graduates (64.5%). In multivariable models, women who identified as racial/ethnic minorities were 2.6 times more likely to report receiving poorer service than others in comparison to NHW women (95% CI, 1.26-5.33, p=0.01). Prior to adjusting for covariates, minority women were also two times more likely to report experiencing a doctor/nurse acting as if they were afraid of them; however, this association was no longer statistically significant with adjustment of covariates (OR, 2.04; 95% CI 0.95-4.39, p=0.07). Associations with income, education, and healthcare discrimination outcomes were not statistically significant. Conclusions: Our findings indicate that racial/ethnic minority women with BRCA1/2 mutations are more likely to experience poorer healthcare service in comparison to their NHW counterparts. Improving patient-provider interactions that can contribute to medical mistrust should be prioritized for the care of high-risk US minority women with BRCA1/2 mutations. Citation Format: Avonne E. Connor, Kate E. Dibble. Disparities in perceived healthcare discrimination among BRCA1/2-positive women from disadvantaged health populations [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-193.