Abstract P3-12-08: Neighborhood disadvantage predicts worse breast cancer-specific survival

Goel, Neha; Choi, Seraphina; Yadegarynia, Sina; Rojas, Kristin E.; Kesmodel, Susan B.; Kobetz, Erin; Westrick, Ashly C.

doi:10.1158/1538-7445.sabcs21-p3-12-08

Cited by 5 publications

(9 citation statements)

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“…Prior studies have identified that neighborhood disadvantage is associated with later stage at presentation, triple negative BC, and shorter survival in women with BC 4,8,30,31 . Disadvantaged neighborhoods are associated with marginalized populations, as economic and residential segregation has roots in structural racism 32 .…”

Section: Discussionmentioning

confidence: 99%

“…As a result, most studies linking neighborhood disadvantage to shorter BC survival attribute this association to disparities in access to care 3–6 . However, recent studies have identified that disparities in BC survival remain between women living in disadvantaged compared with advantaged neighborhoods, even after controlling for multilevel access to care barriers, individual-level factors, tumor characteristics, and receipt of National Cancer Center Network guideline-concordant treatment 7,8 . This suggests unaccounted mechanisms that contribute to persistent BC survival disparities by neighborhood disadvantage.…”

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confidence: 99%

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Impact of Neighborhood Disadvantage on High-Risk Oncotype DX Recurrence Scores and Breast Cancer Survival

Goel,

Hernandez,

Kwon

et al. 2023

Annals of Surgery

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Objective: Evaluate the association between neighborhood disadvantage and Oncotype DX score, a surrogate for tumor biology, among a national cohort. Summary Background Data: Women living in disadvantaged neighborhoods have shorter breast cancer (BC) survival, even after accounting for individual-level, tumor, and treatment characteristics. This suggests unaccounted social and biological mechanisms by which neighborhood disadvantage may impact BC survival. Methods: This cross-sectional study included Stage I and II, ER+ /HER2- BC patients with Oncotype DX score data from the National Cancer Database from 2004-2019. Multivariate regression models tested the association of neighborhood-level income on Oncotype DX score controlling for age, race/ethnicity, insurance, clinical stage, and education. Cox regression assessed overall survival. Results: Of the 294,283 total BC patients selected, the majority were non-Hispanic White (n=237,197, 80.6%) with 7.6% non-Hispanic Black (n=22,495) and 4.5% Other (n=13,383). 27.1% (n=79,7254) of the population lived in the most disadvantaged neighborhoods with an annual neighborhood-level income of <$48,000 while 59.62% (n=175,305) lived in neighborhoods with a median-level income of >$48,000. On multivariate analysis controlling for age, race/ethnicity, insurance status, neighborhood-level education, and pathologic stage, patients in disadvantaged neighborhoods had a greater risk of high- versus low-risk Oncotype DX scores compared to those in advantaged neighborhoods [OR=1.04 (1.01-1.07), P=0.0067]. Conclusion and Relevance: This study takes a translational epidemiologic approach to identify that women living in the most disadvantaged neighborhoods have more aggressive tumor biology, as determined by the Oncotype DX score.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Impact of Neighborhood Disadvantage on High-Risk Oncotype DX Recurrence Scores and Breast Cancer Survival

Goel,

Hernandez,

Kwon

et al. 2023

Annals of Surgery

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“…This residual association of neighborhood disadvantage with survival suggests that there are underlying mechanisms by which neighborhood disadvantage impacts survival that have not been accounted for. 7,8 Many of these studies are limited to specific geographic areas, limiting the generalizability of the study on a national level, or have limitations based on population choice, such as older Medicare patients with fee-for-service coverage, so results may not be generalizable to younger patients or those with other types of insurance. 9,10 Thus, a critical knowledge gap remains regarding whether breast cancer-specific survival disparities persist after accounting for individual, tumor, and treatment characteristics in a national, population-based cohort.…”

Section: Introductionmentioning

confidence: 99%

Neighborhood Disadvantage and Breast Cancer–Specific Survival in the US

Goel,

Hernandez,

Mazul

2024

JAMA Netw Open

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ImportanceDespite improvements in breast cancer screening, treatment, and survival, disparate breast cancer–specific survival outcomes persist, particularly in disadvantaged neighborhoods. Most of these disparities are attributed to disparities in individual, tumor, and treatment characteristics. However, a critical knowledge gap exists as to whether disparities in breast cancer–specific survival remain after accounting for individual, tumor, and treatment characteristics.ObjectiveTo evaluate if neighborhood disadvantage is associated with shorter breast cancer–specific survival after controlling for individual, tumor, and treatment characteristics in a national population.Design, Setting, and ParticipantsThis national retrospective cohort study included patients with breast cancer diagnosed from 2013 to 2018 from the Surveillance, Epidemiology, and End Results 17 Census tract–level socioeconomic status and rurality database of the National Cancer Institute. Data analysis was performed from September 2022 to December 2023.ExposuresNeighborhood disadvantage measured by Yost index quintiles.Main Outcomes and MeasuresBreast cancer–specific survival was evaluated using a competing risks cause-specific hazard model controlling for age, race, ethnicity, rurality, stage, subtype, insurance, and receipt of treatment.ResultsA total of 350 824 patients with breast cancer were included; 41 519 (11.8%) were Hispanic, 39 631 (11.3%) were non-Hispanic Black, and 234 698 (66.9%) were non-Hispanic White. A total of 87 635 patients (25.0%) lived in the most advantaged neighborhoods (group 5) and 52 439 (14.9%) lived in the most disadvantaged neighborhoods (group 1). A larger number of non-Hispanic White patients (66 529 patients [76.2%]) lived in advantaged neighborhoods, while disadvantaged neighborhoods had the highest proportion of non-Hispanic Black (16 141 patients [30.9%]) and Hispanic patients (10 168 patients [19.5%]). Breast cancer–specific survival analysis found the most disadvantaged neighborhoods (group 1) had the highest risk of mortality (hazard ratio, 1.43; 95% CI, 1.36-1.50; P &lt; .001) compared with the most advantaged neighborhoods.Conclusions and RelevanceIn this national cohort study of patients with breast cancer, neighborhood disadvantage was independently associated with shorter breast cancer–specific survival even after controlling for individual-level factors, tumor characteristics, and treatment. This suggests potential unaccounted-for mechanisms, including both nonbiologic factors and biologic factors.

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“…4 Prevailing evidence suggests that disparities in cancer treatment and mortality associated with individuals' race and ethnicity are not fully accounted for by individual-level, clinical, and demographic factors and that neighborhood factors influencing health and health care access could be contributors. [5][6][7][8] There has been growing interest in how area-level measures of socioeconomic status and environment are associated with health outcomes. Area-level measures have been associated with frailty, obesity, and cardiovascular disease as well as access to preventive health care in historically marginalized populations.…”

Section: Introductionmentioning

confidence: 99%

“…Area-level measures have been associated with frailty, obesity, and cardiovascular disease as well as access to preventive health care in historically marginalized populations. [4][5][6]9,10 In regard to cancer-specific outcomes, a higher Social Vulnerability Index (SVI) 11 score has been associated with patients being less likely to receive neoadjuvant chemotherapy or to use high-volume centers for surgical resection and with patients being more likely to encounter fragmented postoperative care. 7,8,11,12 Additionally, area-level factors have been associated with morbidity after controlling for sociodemographic factors among individuals with colorectal and breast cancer.…”

Section: Introductionmentioning

confidence: 99%

Area Vulnerability and Disparities in Therapy for Patients With Metastatic Renal Cell Carcinoma

Rahman,

Long,

Westvold

et al. 2024

JAMA Netw Open

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ImportanceArea-level measures of sociodemographic disadvantage may be associated with racial and ethnic disparities with respect to receipt of treatment for metastatic renal cell carcinoma (mRCC) but have not been investigated previously, to our knowledge.ObjectiveTo assess the association between area-level measures of social vulnerability and racial and ethnic disparities in the treatment of US Medicare beneficiaries with mRCC from 2015 through 2019.Design, Setting, and ParticipantsThis retrospective cohort study included Medicare beneficiaries older than 65 years who were diagnosed with mRCC from January 2015 through December 2019 and were enrolled in fee-for-service Medicare Parts A, B, and D from 1 year before through 1 year after presumed diagnosis or until death. Data were analyzed from November 22, 2022, through January 26, 2024.ExposuresFive different county-level measures of disadvantage and 4 zip code–level measures of vulnerability or deprivation and segregation were used to dichotomize whether an individual resided in the most vulnerable quartile according to each metric. Patient-level factors included age, race and ethnicity, sex, diagnosis year, comorbidities, frailty, Medicare and Medicaid dual enrollment eligibility, and Medicare Part D low-income subsidy (LIS).Main Outcomes and MeasuresThe main outcomes were receipt and type of systemic therapy (oral anticancer agent or immunotherapy from 2 months before to 1 year after diagnosis of mRCC) as a function of patient and area-level characteristics. Multivariable regression analyses were used to adjust for patient factors, and odds ratios (ORs) from logistic regression and relative risk ratios (RRRs) from multinomial logistic regression are reported.ResultsThe sample included 15 407 patients (mean [SD] age, 75.6 [6.8] years), of whom 9360 (60.8%) were men; 6931 (45.0%), older than 75 years; 93 (0.6%), American Indian or Alaska Native; 257 (1.7%), Asian or Pacific Islander; 757 (4.9%), Hispanic; 1017 (6.6%), non-Hispanic Black; 12 966 (84.2%), non-Hispanic White; 121 (0.8%), other; and 196 (1.3%), unknown. Overall, 8317 patients (54.0%) received some type of systemic therapy. After adjusting for individual factors, no county or zip code–level measures of social vulnerability, deprivation, or segregation were associated with disparities in treatment. In contrast, patient-level factors, including female sex (OR, 0.78; 95% CI, 0.73-0.84) and LIS (OR, 0.48; 95% CI, 0.36-0.65), were associated with lack of treatment, with particularly limited access to immunotherapy for patients with LIS (RRR, 0.25; 95% CI, 0.14-0.43). Associations between individual-level factors and treatment in multivariable analysis were not mediated by the addition of area-level metrics. Disparities by race and ethnicity were consistently and only observed within the most vulnerable areas, as indicated by the top quartile of each vulnerability deprivation index.Conclusions and RelevanceIn this cohort study of older Medicare patients diagnosed with mRCC, individual-level demographics, including race and ethnicity, sex, and income, were associated with receipt of systemic therapy, whereas area-level measures were not. However, individual-level racial and ethnic disparities were largely limited to socially vulnerable areas, suggesting that efforts to improve racial and ethnic disparities may be most effective when targeted to socially vulnerable areas.

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Abstract P3-12-08: Neighborhood disadvantage predicts worse breast cancer-specific survival

Cited by 5 publications

References 0 publications

Impact of Neighborhood Disadvantage on High-Risk Oncotype DX Recurrence Scores and Breast Cancer Survival

Impact of Neighborhood Disadvantage on High-Risk Oncotype DX Recurrence Scores and Breast Cancer Survival

Neighborhood Disadvantage and Breast Cancer–Specific Survival in the US

Area Vulnerability and Disparities in Therapy for Patients With Metastatic Renal Cell Carcinoma

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