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Breast cancer treatment delays by socioeconomic and health care access latent classes in Black and White women
Author(s) -
Emerson Marc A.,
Golightly Yvonne M.,
Aiello Allison E.,
ReederHayes Katherine E.,
Tan Xianming,
Maduekwe Ugwuji,
JohnsonThompson Marian,
Olshan Andrew F.,
Troester Melissa A.
Publication year - 2020
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.33121
Subject(s) - medicine , socioeconomic status , quartile , breast cancer , demography , black women , gerontology , cancer , population , confidence interval , gender studies , environmental health , sociology
Background Breast cancer mortality is higher for Black and younger women. This study evaluated 2 possible contributors to disparities—time to treatment and treatment duration—by race and age. Methods Among 2841 participants with stage I‐III disease in the Carolina Breast Cancer Study, we identified groups of women with similar patterns of socioeconomic status (SES), access to care, and tumor characteristics using latent class analysis. We then evaluated latent classes in association with treatment delay (initiation >60 days after diagnosis) and treatment duration (in quartiles by treatment modality). Results Thirty‐two percent of younger Black women were in the highest quartile of treatment duration (versus 22% of younger White women). Black women experienced a higher frequency of delayed treatment (adjusted relative frequency difference [RFD], 5.5% [95% CI, 3.2%‐7.8%]) and prolonged treatment duration (RFD, 8.8% [95% CI, 5.7%‐12.0%]). Low SES was significantly associated with treatment delay among White women (RFD, 3.5% [95% CI, 1.1%‐5.9%]), but treatment delay was high at all levels of SES in Black women (eg, 11.7% in high SES Black women compared with 10.6% and 6.7% among low and high SES White women, respectively). Neither SES nor access to care classes were significantly associated with delayed initiation among Black women, but both low SES and more barriers were associated with treatment duration across both groups. Conclusions Factors that influence treatment timeliness persist throughout the care continuum, with prolonged treatment duration being a sensitive indicator of differences by race, SES, and care barriers.