The effect of patient and contextual characteristics on racial/ethnic disparity in breast cancer mortality
Published Date:Apr 26 2016
Source:Cancer Epidemiol Biomarkers Prev. 25(7):1064-1072.
Pubmed Central ID:PMC4930680
Funding:HHSN261201000034C/CA/NCI NIH HHS/United States
HHSN261201000035C/CA/NCI NIH HHS/United States
HHSN261201000140C/CA/NCI NIH HHS/United States
K05 CA136967/CA/NCI NIH HHS/United States
N01 HD033175/HD/NICHD NIH HHS/United States
R01 CA054281/CA/NCI NIH HHS/United States
R01 CA063446/CA/NCI NIH HHS/United States
R01 CA077398/CA/NCI NIH HHS/United States
R01 CA129059/CA/NCI NIH HHS/United States
R37 CA054281/CA/NCI NIH HHS/United States
U58 DP000807/DP/NCCDPHP CDC HHS/United States
UM1 CA164973/CA/NCI NIH HHS/United States
Racial/ethnic disparity in breast cancer-specific mortality in the U.S. is well documented. We examined whether accounting for racial/ethnic differences in the prevalence of clinical, patient, and lifestyle and contextual factors that are associated with breast cancer-specific mortality can explain this disparity.
The California Breast Cancer Survivorship Consortium combined interview data from six California-based breast cancer studies with cancer registry data to create a large racially diverse cohort of women with primary invasive breast cancer. We examined the contribution of variables in a previously reported Cox regression baseline model plus additional contextual, physical activity, body size, and comorbidity variables to the racial/ethnic disparity in breast cancer-specific mortality.
The cohort comprised 12,098 women. Fifty-four percent were non-Latina Whites, 17% African Americans, 17% Latinas, and 12% Asian Americans. In a model adjusting only for age and study, breast cancer-specific hazard ratios relative to Whites were 1.69 (95% CI 1.46 -1.96), 1.00 (0.84 - 1.19), and 0.52 (0.33 - 0.85) for African Americans, Latinas, and Asian Americans respectively. Adjusting for baseline-model variables decreased disparity primarily by reducing the hazard ratio for African Americans to 1.13 (0.96 - 1.33). The most influential variables were related to disease characteristics, neighborhood socioeconomic status, and smoking status at diagnosis. Other variables had negligible impact on disparity.
While contextual, physical activity, body size, and comorbidity variables may influence breast cancer-specific mortality, they do not explain racial/ethnic mortality disparity.
Other factors besides those investigated here may explain the existing racial/ethnic disparity in mortality.
Supporting Files:No Additional Files
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