Race and Neighborhood Deprivation: Predictors of Survival in Breast Cancer?

By: Jenna Carter, PhD
Posted: Monday, November 20, 2023

Understanding how socioeconomic status influences patient access to health care may highlight how specific inequities influence prognosis and survival. In a presentation at the 2023 American Society of Clinical Oncology (ASCO) Quality Care Symposium (Abstract 174), investigators used linked data from the neighborhood deprivation index and the breast cancer cohort from the Surveillance, Epidemiology, and End Results (SEER) database to analyze the association between race/ethnicity and survival outcomes in patients diagnosed from 2010 to 2016. Arya Mariam Roy, MD, of the Roswell Park Comprehensive Cancer Center, Buffalo, New York, and colleagues found a significant interaction between neighborhood deprivation index and race for both overall and disease-free survival in patients with early-stage breast cancer.

“Inequities in opportunities, education, income, and infrastructure can contribute to worse prognosis and unfavorable outcomes for certain malignancies in areas with lower [socioeconomic status],” stated Dr. Roy and colleagues.

Linked data were used to create a neighborhood deprivation index score for each county, which was classified into quintiles (Q1 = least deprived to Q5 = most deprived). Cox multivariate regression models were then used to analyze the association among neighborhood deprivation index, race/ethnicity, and survival outcomes. Adjustments were made for age, race, grade, insurance, and treatments.

There was a predominance of racial minorities in Q5 and Q4 compared with Q1 quintiles (early stage: Blacks 13%–15% vs 8%; Hispanics 15% vs 6%; advanced stage: Blacks 19%–23% vs 14%; Hispanics 13% vs 7%, P < .001). Findings also revealed there was a higher number of uninsured patients with early-stage cancer in Q5 compared with Q1. Additionally, patients with early-stage disease who live in Q5 quintiles had inferior overall and disease-free survival compared with those living in Q1. There was also a significant interaction between neighborhood depravation index and race for overall survival and disease-free survival (P interaction = .0030 and .02, respectively) for patients with early-stage breast cancer.

Disclosure: The study authors reported no conflicts of interest.

2023 ASCO Quality Care Symposium

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