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

Abstract

AbstractPURPOSE Disparities in breast cancer survival have been observed within marginalized racial/ethnic groups and within the rural-urban continuum for decades. We examined whether there were differences among the intersectionality of race/ethnicity and rural residence on breast cancer outcomes. METHODS We performed a retrospective analysis among 739,448 breast cancer women using Surveillance Epidemiology and End Results (SEER) 18 registries years 2000 through 2016. We conducted multilevel logistic regression and Cox proportional hazards models to estimate adjusted odds ratios (AORs) and hazard ratios (AHRs), respectively, for breast cancer outcomes including surgical treatment, radiation therapy, chemotherapy, late-stage disease, and risk of breast cancer death. Rural was defined as 2013 Rural-Urban Continuum Codes (RUCC) of 4 or greater. RESULTS Compared with non-Hispanic white (NH-white) women, NH-black–urban (U), NH-black–rural (R), Hispanic–U, and Hispanic–R women, respectively, were at increased odds of no receipt of surgical treatment (NH-black–U, AOR = 1.98; NH-black–R, AOR = 1.72, Hispanic–U, AOR = 1.58; and Hispanic–R, AOR = 1.40; p values < 0.05), late-stage diagnosis (NH-black–U, AOR = 1.32; NH-black–R, AOR = 1.29; Hispanic–U, AOR = 1.25; and Hispanic–R, AOR = 1.17; p values < 0.05), and increased risks for breast cancer death (NH-black–U, AHR = 1.67; NH-black–R, AHR = 1.60; and Hispanic–U, AHR = 1.22; p values < 0.05). CONCLUSION Regardless of rurality, NH-black and Hispanic women had significantly increased odds of late-stage diagnosis, no receipt of treatment, and risk of breast cancer death.