The role of socioeconomic status in mediating Black-White racial disparities in endometrial cancer incidence and survival (421)

Navitski, Anastasia; Khoury, Andrea; Rauh-Hain, Alejandro; Wright, Jason D.; Gamble, Charlotte; Melamed, Alexander

doi:10.1016/s0090-8258(22)01643-2

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“…Mediation analysis can quantify the relative contributions of factors on the causal pathway that mediate racial difference in the prevalence of high-risk RS and thereby provide insight into the complex and poorly understood interactions between socioecologic context and tumor biology. Previous mediation analyses have focused primarily on the mediating effects of socioeconomic and insurance status on racial disparities in breast cancer survival and prevalence of late-stage diagnoses . Our aim is to provide an in-depth analysis of the complex association between the social and physical environment and breast tumor biology in racial minoritized women.…”

Section: Introductionmentioning

confidence: 99%

“…Previous mediation analyses have focused primarily on the mediating effects of socioeconomic and insurance status on racial disparities in breast cancer survival and prevalence of late-stage diagnoses. 10 , 16 , 17 , 18 , 19 , 20 , 21 , 22 Our aim is to provide an in-depth analysis of the complex association between the social and physical environment and breast tumor biology in racial minoritized women. The objective of this study was to examine the mediating influence of area-level socioeconomic position (SEP), insurance status, and urban residence on racial and ethnic differences in the prevalence of a high-risk 21-gene RS in a diverse cohort that is representative of the US population.…”

Section: Introductionmentioning

confidence: 99%

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Socioecologic Factors and Racial Differences in Breast Cancer Multigene Prognostic Scores in US Women

Parab,

Kong,

Lee

et al. 2024

JAMA Netw Open

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ImportanceDisproportionately aggressive tumor biology among non-Hispanic Black women with early-stage, estrogen receptor (ER)–positive breast cancer contributes to racial disparities in breast cancer mortality. It is unclear whether socioecologic factors underlie racial differences in breast tumor biology.ObjectiveTo examine individual-level (insurance status) and contextual (area-level socioeconomic position and rural or urban residence) factors as possible mediators of racial and ethnic differences in the prevalence of ER-positive breast tumors with aggressive biology, as indicated by a high-risk gene expression profile.Design, Setting, and ParticipantsThis retrospective cohort study included women 18 years or older diagnosed with stage I to II, ER-positive breast cancer between January 1, 2007, and December 31, 2015. All data analyses were conducted between December 2022 and April 2023.Main Outcomes and MeasuresThe primary outcome was the likelihood of a high-risk recurrence score (RS) (≥26) on the Oncotype DX 21-gene breast tumor prognostic genomic biomarker.ResultsAmong 69 139 women (mean [SD] age, 57.7 [10.5] years; 6310 Hispanic [9.1%], 274 non-Hispanic American Indian and Alaskan Native [0.4%], 6017 non-Hispanic Asian and Pacific Islander [8.7%], 5380 non-Hispanic Black [7.8%], and 51 158 non-Hispanic White [74.0%]) included in our analysis, non-Hispanic Black (odds ratio [OR], 1.33; 95% CI, 1.23-1.43) and non-Hispanic American Indian and Alaska Native women (OR, 1.38; 95% CI, 1.01-1.86) had greater likelihood of a high-risk RS compared with non-Hispanic White women. There were no significant differences among other racial and ethnic groups. Compared with non-Hispanic White patients, there were greater odds of a high-risk RS for non-Hispanic Black women residing in urban areas (OR, 1.35; 95% CI, 1.24-1.46), but not among rural residents (OR, 1.05; 95% CI, 0.77-1.41). Mediation analysis demonstrated that lack of insurance, county-level disadvantage, and urban vs rural residence partially explained the greater odds of a high-risk RS among non-Hispanic Black women (proportion mediated, 17%; P &lt; .001).Conclusions and RelevanceThe findings of this cohort study suggest that the consequences of structural racism extend beyond inequities in health care to drive disparities in breast cancer outcome. Additional research is needed with more comprehensive social and environmental measures to better understand the influence of social determinants on aggressive ER-positive tumor biology among racial and ethnic minoritized women from disadvantaged and historically marginalized communities.

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Section: Introductionmentioning

confidence: 99%