 |
|
Comorbidity and Survival Disparities Among Black and White Patients With Breast Cancer
C. Martin Tammemagi, PhD;
David Nerenz, PhD;
Christine Neslund-Dudas, MA;
Carolyn Feldkamp, PhD;
David Nathanson, MD
JAMA. 2005;294:1765-1772.
Context Reasons for the shorter survival of black breast cancer patients compared with their white counterparts are not completely understood.
Objective To evaluate the role of comorbidity in this racial disparity among breast cancer patients.
Design, Setting, and Patients Historical cohort from the Henry Ford Health System (a large comprehensive health system in Detroit, Mich) followed up for a median of 10 years. Patients (n = 906) included 264 black (29.1%) and 642 white (70.9%) women diagnosed as having breast cancer between 1985 and 1990. Detailed comorbidity data (268 comorbidities) and study data were abstracted from medical records and institutional, Surveillance, Epidemiology, and End Results, and Michigan State registries. Associations were analyzed with logistic and Cox regression.
Main Outcome Measures Breast cancer recurrence/progression and survival to death from all, breast cancer, and competing (non–breast cancer) causes.
Results Of blacks, 64 (24.9%) died of breast cancer and 95 (37.0%) died of competing causes. Comparable data for whites were 115 (18.3%) and 202 (32.1%). Blacks had worse all-cause survival (hazard ratio [HR], 1.34; 95% confidence interval [CI], 1.11-1.62), breast cancer–specific survival (HR, 1.47; 95% CI, 1.08-2.00), and competing-causes survival (HR, 1.27; 95% CI, 1.00-1.63). A total of 77 adverse comorbidities were associated with reduced survival. Adverse comorbidity count was associated with all-cause (adjusted HR, 1.29; 95% CI, 1.19-1.40) and competing-causes survival but was not associated with recurrence/progression or breast cancer–specific survival. At least 1 adverse comorbidity was observed in 221 (86.0%) blacks and 407 (65.7%) whites (odds ratio, 3.20; 95% CI, 2.17-4.72). Comparisons of unadjusted and comorbidity-adjusted HRs indicated that adverse comorbidity explained 49.1% of all-cause and 76.7% of competing-causes survival disparity. Diabetes and hypertension were particularly important in explaining disparity.
Conclusions More black breast cancer patients die of competing causes than of breast cancer. Effective control of comorbidity in black breast cancer patients should help improve life expectancy and lead to a reduction in survival disparities.
Author Affiliations: Department of Community Health Sciences, Brock University, St Catharines, Ontario (Dr Tammemagi); and Center for Health Services Research (Dr Nerenz), Josephine Ford Cancer Center (Ms Neslund-Dudas), Department of Pathology and Laboratory Medicine (Dr Feldkamp), and Department of General Surgery (Dr Nathanson), Henry Ford Health System, Detroit, Mich.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Breast Cancer in Young Women: A New Color or a Different Shade of Pink?
Peppercorn and Partridge
JCO 2008;26:3303-3305.
FULL TEXT
Racial Differences in Clinical Outcomes From Metastatic Breast Cancer: A Pooled Analysis of CALGB 9342 and 9840--Cancer and Leukemia Group B
Polite et al.
JCO 2008;26:2659-2665.
ABSTRACT
| FULL TEXT
Time to Remove the Subspecialty Blinders: Breast Cancer Does Not Exist in Isolation
Giordano and Hortobagyi
JNCI J Natl Cancer Inst 2008;100:230-231.
FULL TEXT
Disparities in Cancer Care
Raghavan et al.
Am Soc Clin Oncol Ed Book 2008;2008:270-273.
ABSTRACT
| FULL TEXT
Exploring the Surgeon Volume Outcome Relationship Among Women With Breast Cancer
Nattinger et al.
Arch Intern Med 2007;167:1958-1963.
ABSTRACT
| FULL TEXT
Lost Opportunities: Physicians' Reasons and Disparities in Breast Cancer Treatment
Bickell et al.
JCO 2007;25:2516-2521.
ABSTRACT
| FULL TEXT
Colorectal Cancer Model of Health Disparities: Understanding Mortality Differences in Minority Populations
Polite et al.
JCO 2006;24:2179-2187.
ABSTRACT
| FULL TEXT
The Ongoing Search for the Sources of the Breast Cancer Survival Disparity
Dignam
JCO 2006;24:1326-1328.
FULL TEXT
Meta-Analysis of Survival in African American and White American Patients With Breast Cancer: Ethnicity Compared With Socioeconomic Status
Newman et al.
JCO 2006;24:1342-1349.
ABSTRACT
| FULL TEXT
Missed Opportunities: Racial Disparities in Adjuvant Breast Cancer Treatment
Bickell et al.
JCO 2006;24:1357-1362.
ABSTRACT
| FULL TEXT
Comorbidity Partly Explains Racial Disparities in Breast Cancer Survival
JWatch General 2005;2005:3-3.
FULL TEXT
|
