Although Socioeconomic status (SES), race/ethnicity, and surgical type/delays are associated with breast cancer mortality outcomes, studies on these associations have been contrasting. This study examined the racial/ethnic and SES differences in surgical treatment types and delays. Also, we quanti ed the extent to which these differences explained the racial/ethnic disparities in breast cancer mortality. MethodsWe studied 290,066 women 40 + years old diagnosed with breast cancer between 2010 and 2017 identi ed from the Surveillance, Epidemiology, and End Results database. We performed logistic regression models to examine the association of SES and race/ethnicity with surgical treatment type and delays. We performed mediation analysis models to quantify the extent to which mortality differences were mediated by treatment, sociodemographic, and clinicopathologic factors. ResultsNon-Hispanic (NH) Black [Odds ratio (OR) = 1.16, 95% CI: 1.13-1.19] and Hispanic women [OR = 1.27, 95% CI: 1.24-1.31] were signi cantly more likely to undergo mastectomy compared to NH White women. Similarly, NH Black and Hispanic women had higher odds of delayed surgical treatment than NH Whites.Patients in the highest SES quintile, compared to those in lowest the lowest, were less likely to experience breast cancer-speci c mortality (BCSM). Variations in treatment, SES, and clinicopathological factors signi cantly explained 70% of the excess BCSM among NH Blacks compared to their NH White counterparts. ConclusionsBridging the gap of access to adequate healthcare services for all to diminish the disproportionate burden of breast cancer would require a multifactorial approach that addresses several biological and social factors that cause these differences.This retrospective cohort study used data from the Surveillance, Epidemiology, and End Results (SEER) research plus 18 registries' specialized census tractlevel SES and rurality dataset released in November 2020. SEER is a cancer surveillance program supported by the National Cancer Institutes (NCI) that serves as the primary source of reliable incidence and survival data in the US. [21]. A detailed database and data collection description can be found elsewhere [21].The study subjects were de-identi ed, and there was no patient contact; thus, the study was exempted from an Institutional Review Board's (IRB) approval.We use SEER*stat version 8.4.0 and identi ed 403,791 women, 40 years old or older, diagnosed with breast cancer as the rst primary cancer between January 2010 and December 2017. From the 403,791 women, our study only included patients who underwent surgery and excluded those who were not recommended for surgery, declined recommended surgery, or had unknown surgery status. In addition, we excluded patients with distant tumor stages, grade IV tumors, and those diagnosed during an autopsy. Lastly, we excluded patients with unknown breast cancer subtypes, tumor grade, tumor stage, tumor site, race, SES, marital status, or rurality. Hence, the sample size used in our analysis was ...
Guaranteeing durability, provenance, accessibility, and trust in open datasets can be challenging for researchers and organizations that rely on public repositories of data critical to epidemiology and other health analytics. Not only are the required repositories sometimes difficult to locate, and nearly always require conversion into a compatible format, they may move or change unpredictably. Any single change of the rules in one repository can hinder updating of a public dashboard reliant on pulling data from external sources. These concerns are particularly challenging at the international level, because systems aimed at harmonizing health and related data are typically dictated by national governments to serve their individual needs. In this paper, we introduce a comprehensive public health data platform, the EpiGraphHub, that aims to provide a single interoperable repository for open health and related data, curated by the international research community, which allows secure local integration of sensitive databases whilst facilitating the development of data-driven applications and reports for decision-makers. The platform development is co-funded by the World Health Organization and is fully open-source to maximize its value for large-scale public health studies.
Objective Although Socioeconomic status (SES), race/ethnicity, and surgical type/delays are associated with breast cancer mortality outcomes, studies on these associations have been contrasting. This study examined the racial/ethnic and SES differences in surgical treatment types and delays. Also, we quantified the extent to which these differences explained the racial/ethnic disparities in breast cancer mortality. Methods We studied 290,066 women 40 + years old diagnosed with breast cancer between 2010 and 2017 identified from the Surveillance, Epidemiology, and End Results database. We performed logistic regression models to examine the association of SES and race/ethnicity with surgical treatment type and delays. We performed mediation analysis models to quantify the extent to which mortality differences were mediated by treatment, sociodemographic, and clinicopathologic factors. Results Non-Hispanic (NH) Black [Odds ratio (OR) = 1.16, 95% CI: 1.13–1.19] and Hispanic women [OR = 1.27, 95% CI: 1.24–1.31] were significantly more likely to undergo mastectomy compared to NH White women. Similarly, NH Black and Hispanic women had higher odds of delayed surgical treatment than NH Whites. Patients in the highest SES quintile, compared to those in lowest the lowest, were less likely to experience breast cancer-specific mortality (BCSM). Variations in treatment, SES, and clinicopathological factors significantly explained 70% of the excess BCSM among NH Blacks compared to their NH White counterparts. Conclusions Bridging the gap of access to adequate healthcare services for all to diminish the disproportionate burden of breast cancer would require a multifactorial approach that addresses several biological and social factors that cause these differences.
585 Background: Breast cancer is the most common malignancy affecting women of all racial and ethnic backgrounds in the United States (US). Although Socioeconomic status (SES), race/ethnicity, and surgical type/delays are associated with breast cancer mortality outcomes, studies on these associations have been contrasting. This study examined the racial/ethnic and SES differences in surgical treatment types and delays. Also, we quantified the extent to which these differences explained the racial/ethnic disparities in breast cancer mortality. Methods: We studied 290,066 women 40+ years old diagnosed with breast cancer between 2010 and 2017 identified from the Surveillance, Epidemiology, and End Results database. We performed logistic regression models to examine the association of SES and race/ethnicity with surgical treatment type and delays. We performed mediation analysis models to quantify the extent to which mortality differences were mediated by treatment, sociodemographic, and clinicopathologic factors. The study subjects were de-identified, and there was no patient contact; thus, the study was exempted from an Institutional Review Board's (IRB) approval. A p-value less than 0.05 indicated significant associations for the descriptive statistics, logistic and Cox proportional hazard regressions, and mediation analysis. We used Stata 17 to perform the analyses. Results: Non-Hispanic (NH) Black [Odds ratio (OR) = 1.16, 95% CI: 1.13-1.19] and Hispanic women [OR = 1.27, 95% CI: 1.24-1.31] were significantly more likely to undergo mastectomy compared to NH White women. Similarly, NH Black and Hispanic women had higher odds of delayed surgical treatment than NH Whites. Patients in the highest SES quintile, compared to those in lowest the lowest, were less likely to experience breast cancer-specific mortality (BCSM). Variations in treatment, SES, and clinicopathological factors significantly explained 70% of the excess BCSM among NH Blacks compared to their NH White counterparts. Conclusions: In conclusion, health disparity continues to be a major societal concern in the US. It affects people of all ages, socioeconomic classes, and ethnic/racial backgrounds. The findings of this study showed that racial and ethnic minorities, the majority of whom have a lower socioeconomic position, are significantly disadvantaged regarding the evaluation, quality, cost, and duration of medical care. Future studies can assess the multifactorial effects of sociodemographic factors like SES, access to health care assessment, and educational background amidst other variables as a multidimensional predictor of treatment delay and overall survival of breast cancer and other health issues among minoritized populations.
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