Dataset Information

Racial/ethnic differences in the outcomes of patients with metastatic breast cancer: contributions of demographic, socioeconomic, tumor and metastatic characteristics.

ABSTRACT:

Purpose

Population-based estimates of racial disparities in metastatic breast cancer are lacking. We quantified the contributions of demographic, socioeconomic, tumor, and metastatic characteristics to racial differences in metastatic breast cancer and characterized the most disproportional subgroup.

Methods

Patients diagnosed with metastatic breast cancer between 2010 and 2014 were identified using the Surveillance, Epidemiology, and End Results database. A multivariable Cox proportional hazards model was used to adjust each set of variables. The excess relative risk of cancer-specific and all-cause death in non-Hispanic black (NHB) versus non-Hispanic white women diagnosed with metastatic breast cancer was expressed as a percentage and was stratified by the age at diagnosis.

Results

We identified 13,066 female patients. NHB women exhibited substantially higher morbidity and mortality than women of other races/ethnicities. The greatest excess mortality risk for NHB women was observed in the young-onset group (18-49 years; hazard ratio: 1.57), followed by the middle-age group (50-64 years; hazard ratio: 1.42); the trend was not significant among the elderly group. Socioeconomic factors stably explained one-half of the excess risk, whereas the contribution of tumor characteristics obviously decreased with age (18-49 years, 40.7%; 50-64 years, 33.9%), and the metastatic pattern accounted for approximately one-tenth of the excess risk. Additionally, the disproportional death burden of NHB women persisted in less aggressive subgroups.

Conclusions

By providing a comprehensive assessment of racial differences in the incidence and outcomes of patients with metastatic breast cancer, we urge the implementation of targeted preventive efforts in both the public health and clinical arenas.

SUBMITTER: Ren JX

PROVIDER: S-EPMC6394580 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Publications

Racial/ethnic differences in the outcomes of patients with metastatic breast cancer: contributions of demographic, socioeconomic, tumor and metastatic characteristics.

Ren Jin-Xiao JX Gong Yue Y Ling Hong H Hu Xin X Shao Zhi-Ming ZM

Breast cancer research and treatment 20181006 1

<h4>Purpose</h4>Population-based estimates of racial disparities in metastatic breast cancer are lacking. We quantified the contributions of demographic, socioeconomic, tumor, and metastatic characteristics to racial differences in metastatic breast cancer and characterized the most disproportional subgroup.<h4>Methods</h4>Patients diagnosed with metastatic breast cancer between 2010 and 2014 were identified using the Surveillance, Epidemiology, and End Results database. A multivariable Cox prop ...[more]

PMID: 30293212

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Project description:ObjectiveTo determine the extent to which socioeconomic and racial/ethnic differences in cancer screening discussion between a patient and his/her primary care physician are due to "within-physician" differences (the fact that patients were treated differently by the same physicians) versus "between-physician" differences (that they were treated by a different group of physicians).Data sourcesWe use data from the baseline patient and physician surveys of two community trials from the Communication in Medical Care (CMC) research series. The two studies combined provide an analysis sample of 5,978 patients ages 50-80 nested within 191 primary care physicians who practiced throughout Southern California.Study designOur main outcomes of interest are whether the physician has ever talked to the patient about fecal occult blood test (FOBT; for colorectal cancer screening), mammogram (for breast cancer screening, female patients only) and the prostate-specific antigen test (PSA, male patients only). We consider five racial/ethnic groups: non-Hispanic white, non-Hispanic black, Hispanic, Asian, and other race/ethnicity. We measure socioeconomic status by both income and education. For each type of cancer screening discussion, we first estimate a probit model that includes patient characteristics as the only covariates to assess the overall differences. We then add physician fixed effects to derive estimates of "within-" versus "between-" physician differences.Principal findingsThere was a strong education gradient in the discussion of all three types of cancer screening and most of the education differences arose within physicians. Disparities by income were less consistent across different screening methods, but seemed to have arisen mainly because of "between-physician" differences. Asians were much less likely, compared with whites, to have received discussion about FOBT and PSA and these differences were mainly "within-physician" differences. Black female patients, however, were much more likely, compared with whites treated by the same physicians, to have discussed mammogram with their physicians.ConclusionsDifferences in cancer screening discussion along the different dimensions of patient SES may have arisen because of very different mechanisms and therefore call for a combination of interventions. Physicians need to be aware of the persistent disparities by patient education in clinical communication regarding cancer screening and tailor their efforts to the needs of low-education patients. Quality-improvement efforts targeted at physicians practicing in low-income communities may also be effective in addressing disparities in cancer screening communication by patient income.

Project description:BACKGROUND & AIMS:Racial and ethnic minorities are reported to have higher mortality related to hepatocellular carcinoma (HCC) than non-Hispanic whites. However, it is not clear whether differences in tumor characteristics or liver dysfunction among racial or ethnic groups affect characterization of causes for this disparity. We aimed to characterize racial and ethnic differences in HCC presentation, treatment, and survival. METHODS:We performed a retrospective study of patients diagnosed with HCC from January 2008 through July 2017 at 2 large health systems in the United States. We used multivariable logistic regression and Cox proportional hazard models to identify factors associated with receipt of curative therapy and overall survival. RESULTS:Among 1117 patients with HCC (35.9% white, 34.3% black, 29.7% Hispanic), 463 (41.5%) were diagnosed with early stage HCC (Barcelona Clinic Liver Cancer stage 0/A) and 322 (28.8%) underwent curative treatment. Hispanic (odds ratio [OR], 0.75; 95% CI, 0.55-1.00) and black patients (OR, 0.74; 95% CI, 0.56-0.98) were less likely to be diagnosed with early stage HCC than white patients. Among patients with early stage HCC, Hispanics were less likely to undergo curative treatment than whites (OR, 0.58; 95% CI, 0.36-0.91). Black patients with early stage HCC were also less likely to undergo curative treatment than white patients, but this difference was not statistically significant (OR, 0.66; 95% CI, 0.43-1.03). Black and Hispanic patients had shorter median survival times than white patients (10.6 and 14.4 mo vs 16.3 mo). After adjusting for type of medical insurance, Child-Pugh class, Barcelona Clinic Liver Cancer stage, and receipt of HCC treatment, black patients had significantly higher mortality (hazard ratio, 1.12; 95% CI, 1.10-1.14) and Hispanic patients had lower mortality (hazard ratio, 0.83; 95% CI, 0.74-0.94) than white patients. CONCLUSIONS:In a retrospective study of patients diagnosed with HCC, we found racial/ethnic differences in outcomes of HCC to be associated with differences in detection of tumors at early stages and receipt of curative treatment. These factors are intervention targets for improving patient outcomes and reducing disparities.

Dataset Information

Racial/ethnic differences in the outcomes of patients with metastatic breast cancer: contributions of demographic, socioeconomic, tumor and metastatic characteristics.

Purpose

Methods

Results

Conclusions

Publications

Racial/ethnic differences in the outcomes of patients with metastatic breast cancer: contributions of demographic, socioeconomic, tumor and metastatic characteristics.

Similar Datasets

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