Age-related differences in breast cancer mortality according to race/ethnicity, insurance, and socioeconomic status
Open Access
- 17 March 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Cancer
- Vol. 20 (1), 1-9
- https://doi.org/10.1186/s12885-020-6696-8
Abstract
We assessed breast cancer mortality in older versus younger women according to race/ethnicity, neighborhood socioeconomic status (nSES), and health insurance status. The study included female breast cancer cases 18 years of age and older, diagnosed between 2005 and 2015 in the California Cancer Registry. Multivariable Cox proportional hazards modeling was used to generate hazard ratios (HR) of breast cancer specific deaths and 95% confidence intervals (CI) for older (60+ years) versus younger (< 60 years) patients separately by race/ethnicity, nSES, and health insurance status. Risk of dying from breast cancer was higher in older than younger patients after multivariable adjustment, which varied in magnitude by race/ethnicity (P-interaction< 0.0001). Comparing older to younger patients, higher mortality differences were shown for non-Hispanic White (HR = 1.43; 95% CI, 1.36–1.51) and Hispanic women (HR = 1.37; 95% CI, 1.26–1.50) and lower differences for non-Hispanic Blacks (HR = 1.17; 95% CI, 1.04–1.31) and Asians/Pacific Islanders (HR = 1.15; 95% CI, 1.02–1.31). HRs comparing older to younger patients varied by insurance status (P-interaction< 0.0001), with largest mortality differences observed for privately insured women (HR = 1.51; 95% CI, 1.43–1.59) and lowest in Medicaid/military/other public insurance (HR = 1.18; 95% CI, 1.10–1.26). No age differences were shown for uninsured women. HRs comparing older to younger patients were similar across nSES strata. Our results provide evidence for the continued disparity in Black-White breast cancer mortality, which is magnified in younger women. Moreover, insurance status continues to play a role in breast cancer mortality, with uninsured women having the highest risk for breast cancer death, regardless of age.Keywords
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Funding Information
- National Cancer Institute (CA023100-29, CA132384)
- National Cancer Institute (CA132379)
- California Department of Public Health (California Health and Safety Code Section 103885)
- National Cancer Institute's Surveillance, Epidemiology and End Results Program (HHSN261201000140C)
- National Cancer Institute’s Surveillance, Epidemiology and End Results Program (HHSN261201000035C, HHSN261201000034C)
- Centers for Disease Control and Prevention’s National Program of Cancer Registries (U58DP003862-01)
This publication has 25 references indexed in Scilit:
- Breast Carcinomas Arising at a Young Age: Unique Biology or a Surrogate for Aggressive Intrinsic Subtypes?Journal of Clinical Oncology, 2011
- Health disparities in breast cancer: biology meets socioeconomic statusBreast Cancer Research and Treatment, 2010
- Breast Cancer in Young Women: Poor Survival Despite Intensive TreatmentPLOS ONE, 2009
- Racial Disparities in Breast Cancer Survival: An Analysis by Age and StageJournal of Surgical Research, 2009
- Elevated Breast Cancer Mortality in Women Younger than Age 40 Years Compared with Older Women Is Attributed to Poorer Survival in Early-Stage DiseaseJournal of the American College of Surgeons, 2009
- Association of Insurance with Cancer Care Utilization and OutcomesCA: A Cancer Journal for Clinicians, 2008
- Breast Cancer Diagnosis in Women ≤ 40 versus 50 to 60 Years: Increasing Size and Stage Disparity Compared With Older Women Over TimeAnnals of Surgical Oncology, 2006
- Insight into the treatment of cancer in older patients: Developments in the last decadeCancer Treatment Reviews, 2006
- The Influence of Marital Status on the Stage at Diagnosis, Treatment, and Survival of Older Women with Breast CancerBreast Cancer Research and Treatment, 2005
- Breast carcinoma in women age 25 years or lessCancer, 2002