DISPARITIES IN LATE-STAGE BREAST/COLORECTAL CANCER DIAGNOSIS AMONG HISPANIC, WHITE, & BLACK TX MEDICARE PATIENTS

Abstract

Abstract Disparities in late-stage breast or colorectal cancer diagnosis in younger populations are associated with Social Determinants of Health-SDOH (education, poverty, housing, employment). We hypothesized that—in older Medicare beneficiaries—disparities in late-stage cancer diagnosis between Hispanics, non-Hispanic Blacks (NHB) and non-Hispanic white (NHW) would be associated with SDOH, comorbidities and primary care-PCP access. We thus used 2005–2017 Texas Cancer Registry data linked with Medicare data for patients aged ≥66 (Nf86,501). Variables included were age at diagnosis, sex, comorbidities, poverty level, education, primary care provider, and breast/colorectal cancer screening within 1 year. For breast cancer in women (Hispanic n=6380, NHW n=39, 225, non-Hispanic Black n=4055), fully adjusted model showed significantly higher odds of late-stage cancer diagnosis only in NH Black patients (OR= 1.11 95% CI= 1.01–1.22) compared with NHW; adjustment for comorbidities and SDOH partially decreased the odds of late-stage diagnosis relative to NWH. Interaction terms between race-ethnicity and poverty were not significant. For colorectal cancer, fully adjusted multivariate model showed significantly higher odds of late-stage diagnosis among Hispanics (n=6053, OR=1.07;95% CI= 1.00–1.15) and NH-Black patients (n=3318, OR=1.29 95% CI= 1.19–1.40) relative to NHW (n=27,470); adjustment for SDOH was associated with a partial decrease in the high odds of late-stage diagnosis in Hispanic and NH Black patients. Interaction terms between race-ethnicity and poverty were not significant. Racial disparities in late-stage breast and colorectal cancer diagnoses remained after adjusting for SDOH and other clinically-relevant factors, underscoring needs for studies on optimizing access to screening and timely cancer treatments in racial/ethnic minorities.