African-American ethnicity, socioeconomic status, and breast cancer survival: A meta-analysis of 14 studies involving over 10,000 African-American and 40,000 white American patients with carcinoma of the breast

BACKGROUND. African-American women are at increased risk for breast cancer mortality compared with white American women, and the extent to which socioeconomic factors account for this outcome disparity is unclear. METHODS. A MEDLINE search was conducted to identify published studies that used a Cox proportional hazards regression model to evaluate the outcome of African-American women and white American women with breast carcinoma after adjusting for socioeconomic status. A meta-analysis was performed using specialized statistical software; the random-effects method of statistical evaluation was used because of the a priori impression that the studies reviewed would be at least moderately heterogeneous in study design and patient populations. RESULTS. The initial literature search yielded 3962 studies. Fourteen studies met all criteria for inclusion in the meta-analysis, resulting in a sample size of 10,001 African-American patients and 42,473 white American patients with breast carcinoma. There was substantial variation in the method used for defining socioeconomic status. Summary statistics revealed a significant odds ratio of 1.22 (95% confidence interval, 1.13-1.30) for the adverse effect of African-American ethnicity on breast cancer mortality. Subset meta-analyses yielded similar results, supporting the robustness of this finding. CONCLUSIONS. This meta-analysis revealed that African-American ethnicity is an independent predictor of a worse breast cancer outcome. The pooled analysis has added strength because of the aggregate sample size and indicates that the true biologic and/or therapeutic determinants of disparities in breast cancer outcome for different ethnic groups and for different socioeconomic strata are incompletely understood.