Journal Article

Age-related differences in breast cancer mortality according to race/ethnicity, insurance, and socioeconomic status

Nodora, Jesse N., Canchola, Alison J., Schwab, Richard B., Murphy, James D., Gomez, Scarlett Lin, San Miguel, Yazmin, Molinolo, Alfredo A., Martinez, Maria Elena, McDaniels-Davidson, Corinne

2020

Overview

Background We assessed breast cancer mortality in older versus younger women according to race/ethnicity, neighborhood socioeconomic status (nSES), and health insurance status. Methods 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. Results 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. Conclusion 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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adolescent / Adult / Age / Age Factors / Aged / Aged, 80 and over / Analysis / Biomedical and Life Sciences / Biomedicine / Breast cancer / Breast Neoplasms - ethnology / Breast Neoplasms - mortality / Cancer Research / Elderly patients / Epidemiology / Ethnicity / Female / Health / Health insurance / Health Promotion and Disease Prevention / Healthcare Disparities / Hispanic American women / Humans / Insurance / Insurance, Health / Medicaid / Medically uninsured persons / Medicine/Public Health / Middle Aged / Mortality / Oncology / Patient outcomes / prevention and public health / Public health / Race Factors / Research Article / Social Class / Socioeconomic factors / Socioeconomic status / Studies / Surgical Oncology / United States - epidemiology / Young Adult / Younger and older age