ASPO Abstracts
New perspectives on racial disparities in breast cancer mortality through the quality of care
Category: Cancer Health Disparities
Conference Year: 2021
Abstract Body:
Purpose: Non-Hispanic Black (NHB) women are more likely to die from breast cancer (BC) mortality compared
with non-Hispanic White (NHW) women, yet there is limited understanding of factors that contribute to this
disparity. We evaluated the contribution of surgical facility characteristics and delay in primary surgical
management to BC mortality disparities between NHB and NHW women residing in Atlanta.
Methods: We identified 2,224 NHB and 3,787 NHW women in the Georgia Cancer Registry, who were diagnosed
in Atlanta with a stage I–III BC (2010–2014). Facility characteristics included annual patient volume, facility type
(non-profit, for-profit, or government), and accreditations, which were abstracted from the NCI Hospital File. Delay
in surgery defined as >30 days from the date of diagnosis. We computed the odds ratios (OR) and 95%
confidence intervals (CI) associating surgical facility characteristics with surgical delay and used Cox proportional
hazards regression to compute the hazard ratios (HR) and 95%CI associating delay and facility characteristics
with BC mortality.
Results: Overall, 63% of NHB women received surgery >30 days after their diagnosis, compared with 49% of
NHW women. Women who received surgery at for-profit and government facilities had a reduced odds of surgical
delay (OR=0.74, 95%CI 0.64, 0.86 and OR=0.45, 95%CI: 0.38, 0.53 respectively) compared with non-profit
facilities. Across all facility characteristics, NHB women were more likely to experience a delay compared with
NHW women. Surgical delay was not associated with BC mortality (HR=1.03, 95%CI 0.85, 1.25). BC patients who
received surgery at for-profit facilities had 1.35-times the mortality rate compared with those who received surgery
at a non-profit facility (95%CI 1.01, 1.40). NHB women who received surgery at a non-profit or for-profit facility had
a nearly 2-fold increase in BC mortality (HR=2.18, 95%CI 1.66, 2.86 and HR=2.21 95%CI 1.29, 3.80,
respectively). Women who received surgery at a government facility, the race disparities were attenuated
(HR=1.23, 95%CI 0.67, 2.26).
Conclusions: Our results suggest that surgical facility characteristics may impact both surgical delay and BC
mortality. However, the impact on patient outcomes varies among NHB and NHW women.
Keywords: Health disparities; Breast cancer mortality; Facility characteristics