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Social Determinants of Racial Disparities in Breast Cancer Mortality Among Black and White Women

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Abstract

Introduction

Mortality from breast cancer among Black women is 60% greater than that of White women in South Carolina (SC). The aim of this study was to assess racial differences in mortality among Black and White breast cancer patients based on variations in social determinants and access to state-based early detection programs.

Methods

We obtained a retrospective record for breast cancer patients diagnosed between 2002 and 2010 from the SC Central Cancer Registry. Mortality was the main outcome while race-stratified Cox proportional hazard models were performed to assess disparities in mortality. We assessed effect modification, and we used an automated backward elimination process to obtain the best fitting models.

Results

There were 3286 patients of which the majority were White women (2186, 66.52%). Compared with married White women, the adjusted hazard ratio (aHR) for mortality was greatest among Black unmarried women (aHR 2.31, CI 1.83, 2.91). Compared with White women who lived in the Low Country region mortality was greatest among Black women who lived in the Midland (aHR 2.17 CI 1.47, 3.21) and Upstate (aHR 2.96 CI 1.96, 2.49). Mortality was higher among Black women that were not receiving services in the Best Chance Network (BCN) program (aHR 1.70, CI 1.40, 2.04) compared with White women.

Conclusions

To reduce the racial disparity gap in survival in SC, Black breast cancer patients who live in the Upstate, are unmarried, and those that are not enrolled in the BCN program may benefit from more intense navigation efforts directed at early detection and linkage to breast cancer treatments.

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Acknowledgments

We will like to appreciate Krystal Johnson (Ph.D.), Director of Research & Planning in the Division of Cancer Prevention & Control in S.C. Dept. of Health & Environmental Control for helping to provide feedbacks about the BCN program and editing the paper.

Funding

A National Cancer Institute’s F99/K00 Fellowship grant (1 F99 CA 222722) as principal investigator supported Oluwole A. Babatunde. A National Cancer Institute’s R15 grant supported Swann A. Adams (R15CA179355) as principal investigator. Samantha Truman is being supported by Interdisciplinary Graduate Training Program in Cancer Disparities (IGniTE-CD) program (GTDR17500160) sponsored by Susan G. Komen.

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Authors and Affiliations

  1. Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA

    Oluwole Adeyemi Babatunde, Jan M. Eberth, Tisha Felder, James R. Hebert & Swann Arp Adams

  2. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA

    Oluwole Adeyemi Babatunde, Jan M. Eberth, Robert Moran, Samantha Truman, James R. Hebert, Jiajia Zhang & Swann Arp Adams

  3. Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA

    Oluwole Adeyemi Babatunde

  4. College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, USA

    Tisha Felder, James R. Hebert & Swann Arp Adams

  5. Connecting Health Innovations LLC, 1417 Gregg Street, Columbia, SC, 29201, USA

    James R. Hebert

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  1. Oluwole Adeyemi Babatunde
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Correspondence to Oluwole Adeyemi Babatunde.

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Conflict of Interest

Dr. James R. Hébert owns a controlling interest in Connecting Health Innovations LLC (CHI), a company planning to license the right to his invention of the DII™ from the University of South Carolina to develop computer and smart applications for patient counseling and dietary intervention in clinical settings. The rest of the authors declare that they have no conflict of interest.

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Babatunde, O.A., Eberth, J.M., Felder, T. et al. Social Determinants of Racial Disparities in Breast Cancer Mortality Among Black and White Women. J. Racial and Ethnic Health Disparities 8, 147–156 (2021). https://doi.org/10.1007/s40615-020-00766-y

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