Racial disparities in setting of care in women with breast cancer in South Carolina.

Abstract

e18146 Background: African American (AA) women with breast cancer (BrCa) suffer a 40% higher mortality burden than White women despite having about equal incidence nationally and lower incidence in South Carolina. Our aim was to describe inpatient and emergency department visits by race and geographic location among BrCa survivors. Methods: We analyzed data from a study (1R15CA179355-01A1; Adams, PI) that combined administrative claims data from South Carolina’s Medicaid Program and a state-based, private-payor health plan to matching BrCA cases from the SC Central Cancer Registry. Race was determined by patient self-report. Geographic location was assigned using designations from the Rural-Urban Commuting Area Codes (RUCA). We used descriptive statistics to characterize the study sample and Chi-square test of independence to compare the descriptive statistics by race and rural/urban continuum. Results: The sample (N = 2723) was 33.6% AA, 91.8% non-Hispanic, primarily married 48.8%, and ranged in age from 14 to 64 years. Most women in the sample lived in an urban area (74.9 %). Most women had Stage I (16.9%), IIA (13.9%), or IIB (7.5%) disease. Women were primarily treated in an outpatient setting; 1.3% (n = 36) were seen in an emergency room and 1.2% (n = 34) were hospitalized. When comparing women living in a rural versus urban area, there were significant differences in TNM stage of disease (by pathology), marital status, race, and setting of care (all p’s ≤ 0.001). When comparing women by race, there were significant differences in age, ethnicity, marital status, stage of disease, and setting of care (all p’s ≤ 0.001). Conclusions: Women with BrCA in SC continue to experience disparities with regard to stage of disease at diagnosis and setting of care. Future research should focus on specific predictors of hospitalization and the relationship of rurality and race with setting of care.