Abstract
Background:
Though extensively studied in the Medicare population, little is known about disparities in mortality in younger women with metastatic breast cancer. Our aim was to examine whether overall survival differed by patient characteristics, region of residence, and time period of diagnosis.
Methods:
We examined administrative data (Optum; Eden Prairie, MN) of members insured through a large national US health insurer. Women with metastatic breast cancer were drawn from an open cohort of members aged 25 to 64 years enrolled between November 1, 2000, and December 31, 2008. Our outcome was time from incident metastatic breast cancer diagnosis to all-cause death, with up to 3 years of follow-up. We stratified by race, age at diagnosis, US region of residence, urban/rural residence, socio-economic status, Adjusted Clinical Groups (ACG) morbidity score, and time period of diagnosis. We constructed Kaplan-Meier survival plots and analyzed overall survival using multivariate Cox proportional hazard models.
Results:
Among 6694 women with incident metastatic breast cancer (73% white, 3% black, 23% other), 1184 women (18%) died within 3 years. We detected accelerated time to death among women residing in predominantly black versus white neighborhoods (adjusted hazard ratio, HR: 1.96; 95% confidence interval, CI: 1.44-2.67), women with high morbidity versus lower morbidity (HR: 1.30; 95% CI: 1.12-1.50), and women whose cancer was diagnosed during 2000-2004 versus 2005-2008 (HR: 1.55; 95% CI: 1.35-1.77). Women living in the Northeast region had longer overall survival compared with women living in the South (HR: 0.71; 95% CI: 0.55-0.92).
Conclusions:
In a cohort of younger commercially insured women with incident metastatic breast cancer, we detected disparities in survival by race, morbidity, and US region of residence. Incident diagnosis between 2005-2008 was associated with improved survival compared with 2000-2004. Research should look for modifiable factors that may explain these differences in survival.
Though extensively studied in the Medicare population, little is known about disparities in mortality in younger women with metastatic breast cancer. Our aim was to examine whether overall survival differed by patient characteristics, region of residence, and time period of diagnosis.
Methods:
We examined administrative data (Optum; Eden Prairie, MN) of members insured through a large national US health insurer. Women with metastatic breast cancer were drawn from an open cohort of members aged 25 to 64 years enrolled between November 1, 2000, and December 31, 2008. Our outcome was time from incident metastatic breast cancer diagnosis to all-cause death, with up to 3 years of follow-up. We stratified by race, age at diagnosis, US region of residence, urban/rural residence, socio-economic status, Adjusted Clinical Groups (ACG) morbidity score, and time period of diagnosis. We constructed Kaplan-Meier survival plots and analyzed overall survival using multivariate Cox proportional hazard models.
Results:
Among 6694 women with incident metastatic breast cancer (73% white, 3% black, 23% other), 1184 women (18%) died within 3 years. We detected accelerated time to death among women residing in predominantly black versus white neighborhoods (adjusted hazard ratio, HR: 1.96; 95% confidence interval, CI: 1.44-2.67), women with high morbidity versus lower morbidity (HR: 1.30; 95% CI: 1.12-1.50), and women whose cancer was diagnosed during 2000-2004 versus 2005-2008 (HR: 1.55; 95% CI: 1.35-1.77). Women living in the Northeast region had longer overall survival compared with women living in the South (HR: 0.71; 95% CI: 0.55-0.92).
Conclusions:
In a cohort of younger commercially insured women with incident metastatic breast cancer, we detected disparities in survival by race, morbidity, and US region of residence. Incident diagnosis between 2005-2008 was associated with improved survival compared with 2000-2004. Research should look for modifiable factors that may explain these differences in survival.
| Original language | English |
|---|---|
| Article number | 18069 |
| Journal | Journal of Clinical Oncology |
| Volume | 34 |
| Issue number | 15 suppl |
| DOIs | |
| Publication status | Published - 20 May 2016 |