Disparities in race/ethnicity and socioeconomic status: risk of mortality of breast cancer patients in the California Cancer Registry, 2000–2010

Carol A Parise,Vincent Caggiano

doi:10.1186/1471-2407-13-449

Carol A Parise, Vincent Caggiano

Open Access

https://doi.org/10.1186/1471-2407-13-449

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Journal: BMC Cancer	Publication Date: Oct 2, 2013
Citations: 144	License type: cc-by

Affiliation: Sutter Institute for Medical Research

Abstract

BackgroundRacial disparities in breast cancer survival have been well documented. This study examines the association of race/ethnicity and socioeconomic status (SES) on breast cancer-specific mortality in a large population of women with invasive breast cancer.MethodsWe identified 179,143 cases of stages 1–3 first primary female invasive breast cancer from the California Cancer Registry from January, 2000 through December, 2010. Cox regression, adjusted for age, year of diagnosis, grade, and ER/PR/HER2 subtype, was used to assess the association of race/ethnicity on breast cancer-specific mortality within strata of stage and SES. Hazard ratios (HR) and 95% confidence intervals were reported.ResultsStage 1: There was no increased risk of mortality for any race/ethnicity when compared with whites within all SES strata. Stage 2: Hispanics (HR = 0.85; 0.75, 0.97) in the lowest SES category had a reduced risk of mortality.. Blacks had the same risk of mortality as whites in the lowest SES category but an increased risk of mortality in the intermediate (HR = 1.66; 1.34, 2.06) and highest (HR = 1.41; 1.15, 1.73) SES categories. Stage 3: Hispanics (HR = 0.74; 0.64, 0.85) and APIs (HR = 0.64; 0.50, 0.82) in the lowest SES category had a reduced risk while blacks had similar mortality as whites. Blacks had an increased risk of mortality in the intermediate (HR = 1.52; 1.20, 1.92) and highest (HR = 1.53; 1.22, 1.92) SES categories.ConclusionsWhen analysis of breast cancer-specific mortality is adjusted for age and year of diagnosis, ER/PR/HER2 subtype, and tumor grade and cases compared within stage and SES strata, much of the black/white disparity disappears. SES plays a prominent role in breast cancer-specific mortality but it does not fully explain the racial/ethnic disparities and continued research in genetic, societal, and lifestyle factors is warranted.

Highlights

Racial disparities in breast cancer survival have been well documented
Expanding on this early attempt to explain how social class or socioeconomic status (SES) relates to breast cancer survival, the objective of this present investigation is to determine if the association of race/ethnicity on breast cancer survival persists when analyses are conducted that compare patients within the same SES category and stage at diagnosis
Cases where race was identified as American Indian (n = 275), Hispanic plus other race (n = 517), or race unknown (n = 1,155) were excluded, which resulted in 179,143 cases with complete data for year of diagnosis, age, race/ethnicity, stage, vital status, and SES

Summary

Introduction

Racial disparities in breast cancer survival have been well documented. This study examines the association of race/ethnicity and socioeconomic status (SES) on breast cancer-specific mortality in a large population of women with invasive breast cancer. Over 40 years ago, the California Cancer Registry (CCR) noted that breast cancer patients treated at private hospitals survived their cancer better than patients treated in public hospitals [24]. Expanding on this early attempt to explain how social class or SES relates to breast cancer survival, the objective of this present investigation is to determine if the association of race/ethnicity on breast cancer survival persists when analyses are conducted that compare patients within the same SES category and stage at diagnosis

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