Racial, ethnic, and socioeconomic disparities in diagnosis, treatment, and survival of patients with breast cancer.

Abstract

e18551 Background: Racial disparities in breast cancer are well established. However, there is a paucity of literature assessing the interaction of patient, socioeconomic, and community factors on outcomes. The objective of this study was to determine the influence of race/ ethnicity, socioeconomic status (SES), and insurance status on disease presentation, access to care, and survival in breast cancer. Methods: A retrospective analysis was performed of Non-Hispanic Black (NHB), Non-Hispanic White (NHW), and Hispanic patients with non-metastatic breast cancer in the SEER cancer registry between 2007 and 2016. Multivariable binary logistic regression and Cox regression analyses were conducted. Results: A total of 382,975 patients were identified; 289,074 (75.5%) NHW, 45,821 (12.0%) NHB, and 48,080 (12.6%) Hispanic patients. On multivariate analysis (see table), NHB (OR 1.18, 95%CI: 1.15-1.20) and Hispanic (OR 1.20, 95%CI: 1.17-1.22) patients were more likely to present with higher stage disease than NHW patients. There was an increased likelihood of not undergoing primary resection in NHB (OR 1.56, 95%CI: 1.49-1.65) and Hispanic (OR 1.41, 95%CI: 1.34-1.48) patients compared to NHWs. Similarly, NHB and Hispanic patients had increased odds of not undergoing breast reconstruction following mastectomy (OR 1.07, 95%CI: 1.03-1.11 and OR 1.60, 95%CI 1.54-1.66, respectively). NHB patients had increased hazard for all-cause mortality (HR: 1.13, 95%CI 1.10-1.16) and breast cancer-specific mortality (HR: 1.20, 95%CI 1.16-1.24). All-cause mortality increased across SES categories (lower SES: HR 1.33, 95%CI 1.30-1.37, middle SES: HR 1.20, 95%CI 1.17-1.23) in NHBs. Conclusions: This population-based analysis confirms worse disease presentation, access to surgical therapy, and survival across racial, ethnic, and socioeconomic factors. These disparities were compounded across worsening SES, suggesting structural racism may partly account for our findings.[Table: see text]