Association between breast cancer mortality-to-incidence ratios and state health disparities in the United States.

Abstract

1548 Background: Breast cancer is the most commonly diagnosed cancer and second leading cause of cancer deaths among women in the United States. The cancer mortality-to-incidence ratio (MIR) provides a population-based indicator of cancer survival and has been established previously to evaluate healthcare variations among different countries. We aim to evaluate the association, which has not been investigated before, between MIR of breast cancer and state-level health disparities in the United States. Methods: We used United States Cancer Statistics (USCS) database to calculate 6-year average of MIRs for breast cancer from 2010 to 2015. America’s Health Rankings (AHR) is a platform using weighted measures in 5 different categories (Behaviors, Community & Environment, Policy, Clinical Care and Outcomes) to determine annual state health rankings. Six-year average (2010-2015) of health uninsured rate by state was obtained from the U.S. Census Bureau and 5-year average (2010-2014) of health spending per capita by state was obtained from Centers for Medicare & Medicaid Services. The correlations between breast cancer MIRs and state health variables were calculated by linear regression analyses. Results: From 2010 through 2015, 1,390,357 females were diagnosed with breast cancer and 246,671 females died from breast cancer in the United States. The 6-year average of age-adjusted incidence rate, mortality rate and MIRs were 124.2 ± 1.3 per 100,000 population, 21.1 ± 0.6 per 100,000 and 0.170 ± 0.007, respectively. Among fifty states we included for analyses, Hawaii had the lowest MIR (0.116 ± 0.014) and Nevada had the highest MIR (0.204 ± 0.004). AHR showed Hawaii had the highest health ranking (No. 1) whereas Louisiana had the lowest health ranking (No. 50) in 2015. In our analysis, states with better health rankings, lower health uninsured rates and higher health spending per capita were significantly correlated with lower MIRs (R2 = 0.695, 0.453 and 0.253, respectively; all P < 0.001). Conclusions: The difference of MIRs for breast cancer was strongly associated with state health diversities. These findings suggest that MIR of breast cancer can be an applicable measure to evaluate and reflect the state-level health disparities in the United States. [Table: see text]