Integrating Access to Care and Tumor Patterns by Race and Age in the Carolina Breast Cancer Study, 2008-2013

Citation

Emerson, Marc A.; Golightly, Yvonne M.; Tan, Xianming; Aiello, Allison E.; Reeder-Hayes, Katherine E.; Olshan, Andrew F.; Earp, H. Shelton; & Troester, Melissa A. (2020). Integrating Access to Care and Tumor Patterns by Race and Age in the Carolina Breast Cancer Study, 2008-2013. Cancer Causes & Control, 31(3), 221-230. PMCID: PMC7188189

Abstract

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.

URL

http://dx.doi.org/10.1007/s10552-019-01265-0

Reference Type

Journal Article

Year Published

2020

Journal Title

Cancer Causes & Control

Author(s)

Emerson, Marc A.
Golightly, Yvonne M.
Tan, Xianming
Aiello, Allison E.
Reeder-Hayes, Katherine E.
Olshan, Andrew F.
Earp, H. Shelton
Troester, Melissa A.

Article Type

Regular

PMCID

PMC7188189

Data Set/Study

Carolina Breast Cancer Study (CBCS)
Behavioral Risk Factor Surveillance System (BRFSS)

Continent/Country

United States of America

State

North Carolina

Sex/Gender

Women

ORCiD

Olshan - 0000-0001-9115-5128
Aiello - 0000-0001-7029-2537