Impact of socioeconomic and medical factors on racial disparities in time to treatment initiation and survival in breast cancer patients.

Abstract

e18583 Background: Delays in breast cancer treatment have been associated with adverse outcomes. Previously, we observed longer time to treatment initiation (TTT) and inferior overall survival (OS) among Black versus White patients with breast cancer. We aim to examine the extent to which social, and medical factors influence these outcomes. Methods: Women over age 18 who identified as Black or White and diagnosed with stage I-IV breast cancer between 2015 and 2020 at the Cleveland Clinic were identified. Variables included were age, race, type of insurance, receptor status, hypertension, type 2 diabetes, CKD stage 3/4, obesity, and tobacco use. Characteristics according to race were analyzed by the Chi-squared test for categorical variables and the Wilcoxon rank sum test for continuous variables. The primary outcomes were TTT and OS. TTT was analyzed using multivariable linear regression and OS was analyzed using multivariable Cox regression. Results: Patient characteristics by race are shown in Table. Black patients were older, more frequently had triple-negative (TN) receptor status and comorbidities, and less frequently had private insurance. On multivariable linear regression Black race and increased age were associated with longer TTT (both p < 0.001) whereas TN vs HR+/HER2- was associated with shorter TTT (p = 0.007). On multivariable Cox regression Black race (HR 1.39; p = 0.009), increased age (HR 1.02; p < 0.001), Medicaid/Medicare (HR 1.91) or other insurance (HR 1.68) vs private insurance (p < 0.001), type 2 diabetes (HR 1.55; p = 0.001), CKD stage 3/4 (HR 1.93; p < 0.001), and HER2+ (HR 1.44) or TN (HR 2.41) vs HR+/HER2- (p < 0.001) were associated with increased hazard of death .Obesity (HR 0.73; p <0.025) was associated with decreased hazard of death. Conclusions: Our study highlights racial disparities in breast cancer outcomes including the potential contribution of medical and socioeconomic factors. Further investigation will identify the relative contribution of patient related factors on TTT and OS and explore their impact on breast cancer recurrence. It is critically important for providers to attempt to understand factors contributing to disparities in order to implement interventions that can attempt to limit them.[Table: see text]