Social Determinants of Racial Disparities in Breast Cancer Mortality Among Black and White Women

106 Background: Racial/ethnic disparities in breast cancer mortality have been described. Geographic variation in breast cancer mortality has also been observed. The purpose of this study is to determine if there are racial disparities in breast cancer survival among eight regions in California, the most populous state in the U.S. Methods: Of 245,701 cases of first primary female invasive breast cancer from the California Cancer Registry (CCR) diagnosed in 2000-2011, we identified 143,184 with complete data. The regions of California were classified as North, Sacramento, San Francisco and Bay Area (SFBA), Central Valley, Tri-County, Desert Sierra, Los Angeles (LA), and San Diego/Orange. Cox Proportional Hazards was conducted to assess risk of mortality of African Americans, Hispanics, Asian/Pacific Islanders, and American Indians when compared with whites. The region X race interaction was tested. Analyses were adjusted for year of diagnosis, stage at diagnosis, grade, age, and socioeconomic status. Hazard ratios and 95% confidence intervals were reported. Results: The region X race/ethnicity interaction was statistically significant so separate models were fitted for each region. Blacks has increased mortality in SFBA (HR = 1.36; 1.20, 1.56), LA (HR = 1.37; 1.24, 1.51) and San Diego/Orange (HR = 1.31; 1.07, 1.60). American Indians had an increased risk of mortality in the Tri-County (HR = 3.90; 1.73, 8.78) and San Diego (HR = 1.93; 1.04, 3.64) regions. Hispanics had a reduced risk mortality only in the Tri County region (HR = 0.71; 0.55, 0.93). Asians had a lower risk of mortality in San Diego/Orange (HR = 0.81; 0.70. 0.94) and LA (HR = 0.78; 0.70; 0.87). Race was not a statistically significant factor for risk of mortality in the North, Sacramento, Central Valley, and Desert Sierra regions. Conclusions: Racial disparities in breast cancer mortality California vary by region and appear to be more prevalent in large urban areas.

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Age-Related Crossover in Breast Cancer Incidence Rates between Black and White Women: Implications for Removing Racial Disparities in Breast Cancer Care

Breast Diseases A Year Book Quarterly ◽

10.1016/s1043-321x(09)79313-0 ◽

2009 ◽

Vol 20 (2) ◽

pp. 132-134

Author(s):

William F. Anderson ◽

Ismail Jatoi

Keyword(s):

Breast Cancer ◽

Racial Disparities ◽

Cancer Incidence ◽

White Women ◽

Breast Cancer Incidence ◽

Incidence Rates ◽

Breast Cancer Care ◽

Black And White ◽

Age Related ◽

Cancer Incidence Rates

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Racial Disparities in Breast Cancer Mortality—Response

Cancer Epidemiology Biomarkers & Prevention ◽

10.1158/1055-9965.epi-11-0148 ◽

2011 ◽

Vol 20 (5) ◽

pp. 1047-1047

Author(s):

Nicolien T. van Ravesteyn ◽

Clyde B. Schechter ◽

Aimee M. Near ◽

Eveline A.M. Heijnsdijk ◽

Michael A. Stoto ◽

...

Keyword(s):

Breast Cancer ◽

Racial Disparities ◽

Cancer Mortality ◽

Breast Cancer Mortality ◽

Mortality Response

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Investigation of Racial Disparities in Early Supportive Medication Use and End-of-Life Care Among Medicare Beneficiaries With Stage IV Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2015.64.8162 ◽

2016 ◽

Vol 34 (19) ◽

pp. 2265-2270 ◽

Cited By ~ 19

Author(s):

Devon K. Check ◽

Cleo A. Samuel ◽

Donald L. Rosenstein ◽

Stacie B. Dusetzina

Keyword(s):

Breast Cancer ◽

Racial Disparities ◽

End Of Life ◽

End Of Life Care ◽

White Women ◽

Medication Use ◽

Stage Iv ◽

Life Care ◽

Black And White ◽

Stage Iv Breast Cancer

Purpose Early supportive care may improve quality of life and end-of-life care among patients with cancer. We assessed racial disparities in early use of medications for common cancer symptoms (depression, anxiety, insomnia) and whether these potential disparities modify end-of-life care. Methods We used 2007 to 2012 SEER-Medicare data to evaluate use of supportive medications (opioid pain medications and nonopioid psychotropics, including antidepressants/anxiolytics and sleep aids) in the 90 days postdiagnosis among black and white women with stage IV breast cancer who died between 2007 and 2012. We used modified Poisson regression to assess the relationship between race and supportive treatment use and end-of-life care (hospice, intensive care unit, more than one emergency department visit or hospitalization 30 days before death, in-hospital death). Results The study included 752 white and 131 black women. We observed disparities in nonopioid psychotropic use between black and white women (adjusted risk ratio [aRR], 0.51; 95% CI, 0.35 to 0.74) but not in opioid pain medication use. There were also disparities in hospice use (aRR, 0.86; 95% CI, 0.74 to 0.99), intensive care unit admission or more than one emergency department visit or hospitalization 30 days before death (aRR, 1.28; 95% CI, 1.01 to 1.63), and risk of dying in the hospital (aRR, 1.59; 95% CI, 1.22 to 2.09). Supportive medication use did not attenuate end-of-life care disparities. Conclusion We observed racial disparities in early supportive medication use among patients with stage IV breast cancer. Although they did not clearly attenuate end-of-life care disparities, medication use disparities may be of concern if they point to disparities in adequacy of symptom management given the potential implications for quality of life.

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