Exploring the intersectionality of race/ethnicity with rurality on breast cancer outcomes: SEER analysis, 2000–2016

Moore, Justin Xavier; Andrzejak, Sydney Elizabeth; Jones, Samantha R.; Han, Yunan

doi:10.1007/s10549-022-06830-x

Cited by 10 publications

(4 citation statements)

References 62 publications

(87 reference statements)

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“…Moore et. al.’s study found that despite living in closer proximity to available healthcare services, increased odds of late-stage diagnosis, no receipt of treatment, and risk of breast cancer death were sustained for NH-AA women living in urban environments compared to rural NH-AA women [ 35 ]. One explanation to our findings may be a relative homogeneity in AL in AA women.…”

Section: Discussionmentioning

confidence: 99%

Investigating the association between educational attainment and allostatic load with risk of cancer mortality among African American women

Li,

Andrzejak,

Jones

et al. 2023

BMC Women's Health

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Background African American (AA) women navigate the world with multiple intersecting marginalized identities. Accordingly, AA women have higher cumulative stress burden or allostatic load (AL) compared to other women. Studies suggest that AA women with a college degree or higher have lower AL than AA women with less than a high school diploma. We examined the joint effect of educational attainment and AL status with long-term risk of cancer mortality, and whether education moderated the association between AL and cancer mortality. Methods We performed a retrospective analysis among 4,677 AA women within the National Health and Nutrition Examination Survey (NHANES) from 1988 to 2010 with follow-up data through December 31, 2019. We fit weighted Cox proportional hazards models to estimate adjusted hazard ratios (aHRs) of cancer death between educational attainment/AL (adjusted for age, income, and smoking status). Results AA women with less than a high school diploma living with high AL had nearly a 3-fold increased risk (unadjusted HR: 2.98; 95%C CI: 1.24–7.15) of cancer death compared to AA college graduates living with low AL. However, after adjusting for age, this effect attenuated (age-adjusted HR: 1.11; 95% CI: 0.45–2.74). AA women with high AL had 2.3-fold increased risk of cancer death (fully adjusted HR: 2.26; 95% CI: 1.10–4.57) when compared to AA with low AL, specifically among women with high school diploma or equivalent and without history of cancer. Conclusions Our findings suggest that high allostatic load is associated with a higher risk of cancer mortality among AA women with lower educational attainment, while no such association was observed among AA women with higher educational attainment. Thus, educational attainment plays a modifying role in the relationship between allostatic load and the risk of cancer death for AA women. Higher education can bring several benefits, including improved access to medical care and enhanced medical literacy, which in turn may help mitigate the adverse impact of AL and the heightened risk of cancer mortality among AA women.

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Section: Discussionmentioning

confidence: 99%

Investigating the association between educational attainment and allostatic load with risk of cancer mortality among African American women

Li,

Andrzejak,

Jones

et al. 2023

BMC Women's Health

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“…For instance, patients who present at later stages may require more intense treatment regimens or may have less treatment options available to them compared with if they presented earlier. Six of the identified articles addressed this disparity, with 4 identifying a disparity [32][33][34][35] and 2 finding no relationship with the Hispanic population. 36,37 One of the identified studies, by Moore et al, 34 identified that regardless of rural versus urban location, patients with breast cancer that identified as Hispanic were more likely to present with latestage disease at diagnosis compared with non-hispanic white (NHW) patients (Hispanic-Urban: adjusted odds ratio [aOR] 1.25, Hispanic-Rural: aOR 1.75).…”

Section: Stage At Presentationmentioning

confidence: 99%

“…Five articles evaluated disparities regarding geography, including length of travel for treatment. Of the 5 articles identified, 4 identified a disparity for the Hispanic population 23,24,34,55 and 1 did not. 56 These articles found that regardless of location, Hispanic ethnicity was associated with less likelihood of receiving treatment, 23,34 that Hispanic patients had greater distance to travel to an RT treatment center, 55 and that Hispanic patients are less likely to travel far distances for treatment, worsening outcomes.…”

Section: Geographymentioning

confidence: 99%

Disparities in Access to Radiotherapy Among Hispanic/Latinx Populations in the United States

Verdini,

Santos,

Vicioso-Mora

et al. 2023

American Journal of Clinical Oncology

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Objectives: The Hispanic/Latinx population has consistently faced disparities in oncology access and outcomes with cancer being the leading cause of death in this population. We evaluate recent research in radiation therapy disparities among the Hispanic/Latinx population in the United States since our seminal analysis from 2017. Methods: A PubMed literature search was conducted for articles published from January 2017 through March 2023. Four term combinations were utilized, including: (1) “Hispanic” and “Radiotherapy” and “Disparities”, (2) “Latino” and “Radiotherapy” and “Hispanic”, (3) “Hispanic” and “Radiation” and “Disparities”, and (4) “Latino” and “Radiation” and “Disparities.” Included studies were those taking place in the United States, examined radiation oncology care, and examined health disparities. Results: Fifty-eight of 245 articles returned met inclusion criteria and spanned 6 disparity-types: (1) Stage at Presentation, (2) Time to Treatment Initiation & Completion, (3) Receipt of Treatment and Guideline-Concordant Care, (4) Geography, (5) Clinical Trial Access and (6) Insurance Barriers and Treatment Center Type. The most common disparity was receipt of treatment and guideline-concordant care (n=39 studies), demonstrating that the Hispanic/Latinx population was less likely to receive guideline-concordant treatment or treatment at all. In additon, studies identified disparities in time to treatment and completion (n=12), geography (n=5), clinical trial access (n=3), and insurance and treatment center access (n=5). Conclusions: Disparities in radiotherapy access remain prominent for the Hispanic/Latinx population through a multitude of barriers, despite increasing interest in disparities research. Continued health care disparities research with tangible interventions are needed in radiation oncology to properly understand and address this problem.

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“…Studies examining the impact of therapy duration on survival across these groups have identified significant differences in time to treatment initiation and survival [10,11]. Many factors affecting disparities in breast cancer have been identified, including social and health determinants along with individualized and tumor-related factors [12][13][14][15][16]. However, many studies have prioritized establishing association rather than examining the causal mechanisms underlying these associations [17,18], and many studies rely on cancer registry data, which often do not contain the information needed to assess such mechanisms.…”

Section: Introductionmentioning

confidence: 99%

Ethnoracial Disparities in Breast Cancer Treatment Time and Survival: A Systematic Review With a DAG-based Causal Model

Hesari,

James,

Lizotte

et al. 2024

Preprint

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For interventions aimed at redressing health disparities in breast cancer to be effective, a clear understanding of the nature and causes of these disparities is required. Our question is: what is the current evidence for ethnoracial disparities in time-to-treatment initiation and survival in breast cancer, and how are the causal mechanisms of these disparities conceptualized in the literature? A comprehensive systematic search of studies on cohorts of female breast cancer patients diagnosed with stage I-III was performed. Directed acyclic graphs were used to describe implicit causal relationships between ethnoracial group membership and time-to-treatment initiation and survival outcomes. This review revealed strong evidence for ethnoracial disparities in both time to treatment and survival among breast cancer patients. Unmeasured factors identified by the authors highlighted gaps in data sources and opportunities for causal reasoning. While the existing literature describes ethnoracial disparities, there is very limited discussion of causal mechanisms, and no discussion of system-level rather than individual-level effects. In response, a biosocioecological model of breast cancer disparity was developed to integrate system-level considerations into future research. Addressing established ethnoracial disparities in breast cancer requires new research that explicitly considers the causal mechanisms of potential interventions, incorporating unmeasured factors contributing to these disparities.

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Exploring the intersectionality of race/ethnicity with rurality on breast cancer outcomes: SEER analysis, 2000–2016

Cited by 10 publications

References 62 publications

Investigating the association between educational attainment and allostatic load with risk of cancer mortality among African American women

Investigating the association between educational attainment and allostatic load with risk of cancer mortality among African American women

Disparities in Access to Radiotherapy Among Hispanic/Latinx Populations in the United States

Ethnoracial Disparities in Breast Cancer Treatment Time and Survival: A Systematic Review With a DAG-based Causal Model

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