Racial disparities in breast cancer outcomes in the metropolitan Atlanta area: New insights and approaches for health equity

• Authors: Lindsay J. Collin, Emory University; Renjian Jiang, Emory University; Kevin Ward, Emory University; Keerthi Gogineni, Emory University; Preeti Subhedar, Emory University; Mark E. Sherman, Mayo Clinic in Jacksonville, Florida; Mia Gaudet, Emory University; Carmen Radecki Breitkopf, Mayo Clinic; Olivia D'Angelo, Emory University School of Medicine; Sheryl Gabram-Mendola, Emory University; Ritu Aneja, Georgia State University; Anne H. Gaglioti, Morehouse School of Medicine; Lauren McCullough, Emory University
• Journal Title: JNCI Cancer Spectrum
• Volume: Volume 3, Number 3
• Publisher: Oxford | 2019-09-01, Pages pkz053-pkz053
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1093/jncics/pkz053
• Subjects: Sociology, Ethnic and Racial Studies; Health Sciences, Oncology; Health Sciences, Obstetrics and Gynecology
• Keywords: racial disparities; breast cancer; outcomes; non-Hispanic black; women; non-Hispanic white; patient characteristics; tumor; treatment; Atlanta; stage I–IV BC; hazard ratios

Abstract

Background: Racial disparities in breast cancer (BC) outcomes persist where non-Hispanic black (NHB) women are more likely to die from BC than non-Hispanic white (NHW) women, and the extent of this disparity varies geographically. We evaluated tumor, treatment, and patient characteristics that contribute to racial differences in BC mortality in Atlanta, Georgia, where the disparity was previously characterized as especially large. Methods: We identified 4943 NHW and 3580 NHB women in the Georgia Cancer Registry with stage I-IV BC diagnoses in Atlanta (2010-2014). We used Cox proportional hazard regression to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) comparing NHB vs NHW BC mortality by tumor, treatment, and patient characteristics on the additive and multiplicative scales. We additionally estimated the mediating effects of these characteristics on the association between race and BC mortality. Results: At diagnosis, NHB women were younger-with higher stage, node-positive, and triple-negative tumors relative to NHW women. In age-adjusted models, NHB women with luminal A disease had a 2.43 times higher rate of BC mortality compared to their NHW counterparts (95% CI = 1.99 to 2.97). High socioeconomic status (SES) NHB women had more than twice the mortality rates than their white counterparts (HR = 2.67, 95% CI = 1.65 to 4.33). Racial disparities among women without insurance, in the lowest SES index, or diagnosed with triple-negative BC were less pronounced. Conclusions: In Atlanta, the largest racial disparities are observed in luminal tumors and most pronounced among women of high SES. More research is needed to understand drivers of disparities within these treatable features.