Association between Neighborhood Social Deprivation and Stage at Diagnosis among Breast Cancer Patients in South Carolina

Abstract

The purpose of this study was to examine the association between neighborhood social deprivation and individual-level characteristics on breast cancer staging in African American and white breast cancer patients. We established a retrospective cohort of patients with breast cancer diagnosed from 1996 to 2015 using the South Carolina Central Cancer Registry. We abstracted sociodemographic and clinical variables from the registry and linked these data to a county-level composite that captured neighborhood social conditions—the social deprivation index (SDI). Data were analyzed using chi-square tests, Student’s t-test, and multivariable ordinal regression analysis to evaluate associations. The study sample included 52,803 female patients with breast cancer. Results from the multivariable ordinal regression model demonstrate that higher SDI (OR = 1.06, 95% CI: 1.02–1.10), African American race (OR = 1.35, 95% CI: 1.29–1.41), and being unmarried (OR = 1.17, 95% CI: 1.13–1.22) were associated with a distant stage at diagnosis. Higher tumor grade, younger age, and more recent year of diagnosis were also associated with distant-stage diagnosis. As a proxy for neighborhood context, the SDI can be used by cancer registries and related population-based studies to identify geographic areas that could be prioritized for cancer prevention and control efforts.

Exploring perceptions, knowledge, and attitudes regarding pharmacogenetic testing in the medically underserved

“…Given the challenges associated with precisely identifying a medically underserved population in an online and mobile based nationwide survey, the characteristics of our sample-lower levels of education, lacking health insurance or being on Medicaid, lower levels of healthcare utilization, economically constrained, and needing an improvement in health-are in line with a medically underserved population. Additionally, the median SDI score in our study is similar to what is noted in other studies of disadvantaged and underserved populations (Patel et al, 2020;Green et al, 2022) and is higher than noted in the assessment of general patient populations (Babatunde et al, 2021;Babatunde et al, 2022).…”

The Persistence of Poverty and its Impact on Cancer Diagnosis, Treatment and Survival

“…This increased risk was also present, to an equivalent or diminished degree, when comparing patients living in current, but not persistent, poverty counties and ultimately disappeared when evaluating patients in counties that were no longer in poverty. These findings align with previous work that demonstrate that the social deprivation of a neighborhood impacts stage of diagnosis—as patients with lung and breast cancer in more vulnerable environments more often present with advanced stage disease 27,28. This is thought to be in part due to screening rates, access and cost.…”

“…These findings align with previous work that demonstrate that the social deprivation of a neighborhood impacts stage of diagnosis-as patients with lung and breast cancer in more vulnerable environments more often present with advanced stage disease. 27,28 This is thought to be in part due to screening rates, access and cost. Interestingly, there were no differences in colorectal cancer, which differs from previously published work evaluating county-level poverty, but may reflect the complicated intersection between race, rurality and poverty in this particular cohort.…”

Social Deprivation and End-of-Life Care Use Among Adults With Cancer

“…1 Individuals with cancer residing in more socioeconomically disadvantaged areas often experience limited access to cancer screening and treatment and thereby tend to present with more advanced stages of disease. [2][3][4][5] Individuals experiencing socioeconomic disadvantage are also at greater risk of dying from cancer and at earlier age than socioeconomically advantaged individuals. 6 Socioeconomically disadvantaged populations often experience multiple risk factors for poorer health that intersect and amplify one another.…”