Integrating access to care and tumor patterns by race and age in the Carolina Breast Cancer Study, 2008–2013

• Published in: Cancer causes & control 2020-03, Vol.31 (3), p.221-230
• Main Authors: Emerson, Marc A., Golightly, Yvonne M., Tan, Xianming, Aiello, Allison E., Reeder-Hayes, Katherine E., Olshan, Andrew F., Earp, H. Shelton, Troester, Melissa A.
• Format: Article
• Language: English
• Subjects: Adult; African Americans - statistics & numerical data; Age; Aged; Biomedical and Life Sciences; Biomedicine; Breast cancer; Breast Neoplasms - ethnology; Breast Neoplasms - mortality; Cancer Research; Comorbidity; Confidence intervals; Epidemiology; Female; Health Services Accessibility - statistics & numerical data; Hematology; Heterogeneity; Humans; Logistic Models; Middle Aged; North Carolina - epidemiology; Odds Ratio; Oncology; Original Paper; Public Health; Risk analysis; Risk factors; Risk taking; Social Class; Socioeconomic Factors; Socioeconomics; Statistical analysis; Tumors; Womens health
• ISSN: 0957-5243; 1573-7225
• DOI: 10.1007/s10552-019-01265-0

Purpose Understanding breast cancer mortality disparities by race and age is complex due to disease heterogeneity, comorbid disease, and the range of factors influencing access to care. It is important to understand how these factors group together within patients. Methods We compared socioeconomic status (SES) and comorbidity factors in the Carolina Breast Cancer Study Phase 3 (CBCS3, 2008–2013) to those for North Carolina using the 2010 Behavioral Risk Factor Surveillance Study. In addition, we used latent class analysis of CBCS3 data to identify covariate patterns by SES/comorbidities, barriers to care, and tumor characteristics and examined their associations with race and age using multinomial logistic regression. Results Major SES and comorbidity patterns in CBCS3 participants were generally similar to patterns in the state. Latent classes were identified for SES/comorbidities, barriers to care, and tumor characteristics that varied by race and age. Compared to white women, black women had lower SES (odds ratio (OR)  6.3, 95% confidence interval (CI) 5.2, 7.8), more barriers to care (OR 5.6, 95% CI 3.9, 8.1) and several aggregated tumor aggressiveness features. Compared to older women, younger women had higher SES (OR 0.5, 95% CI 0.4, 0.6), more barriers to care (OR 2.1, 95% CI 1.6, 2.9) and aggregated tumor aggressiveness features. Conclusions CBCS3 is representative of North Carolina on comparable factors. Patterns of access to care and tumor characteristics are intertwined with race and age, suggesting that interventions to address disparities will need to target both access and biology.