Socioeconomic inequities in care experienced by women with breast cancer in England: An intersectional cross-sectional study

Abstract

PurposeGuided by the intersectionality framework, we examined the differential in breast cancer care experience across population subgroups in England.MethodsSecondary data analysis using the 2017/2018 English National Cancer Patient Experience Survey (NCPES). We applied disaggregated descriptive statistics (mean, standard errors, 95% confidence interval) to analyse 26,030 responses from female breast cancer patients to a question relating to overall care experience categorised by age, ethnicity, and sexual orientation in their intersection with deprivation status. We then applied multivariable logistic regression (odds ratios, 95% confidence intervals) to ascertain the relationship of reporting a positive care experience adjusting for patient, clinical, and trust-level factors.ResultsPoorer breast cancer care experience was mostly reported by the most deprived younger and minoritised ethnic groups. Similar findings were observed in adjusted multivariable analyses. Younger respondents were less likely than older patients to rate their care favourably. Pakistani, Indian, Chinese, and Black African women were less likely than White British women to rate their care favourably. Respondents from the most socioeconomic deprived backgrounds were less likely than the most affluent ones to rate their care favourably.ConclusionThere is evidence of inequity in overall cancer care experience among female breast cancer patients in England, particularly among women living at the specific intersection of age, ethnicity and socioeconomic position. Future research is necessary to understand the mechanisms underlying breast cancer inequities. Policymakers, commissioners, and providers should consider the existence of multiple forms of marginalization to inform improvement initiatives targeting patients at higher risk of vulnerability.