Racialized Economic Segregation, Treatment, and Outcomes in Women with Triple-Negative Breast Cancer

Background: We previously demonstrated differences in breast cancer-specific mortality [HR = 1.14; 95% confidence treatment and mortality between non-Hispanic Black (NHB) and interval (CI), 1.01-1.30; P_trend = 0.12], overall mortality non-Hispanic White (NHW) women with triple-negative breast (HR = 1.15; 95% CI, 1.02-1.29; P_trend = 0.06), and late-stage cancer (TNBC). The impact of residential segregation on TNBC diagnosis (OR = 1.15; 95% CI, 1.01-1.32; P_trend = 0.03). treatment and outcomes remains unknown. Overall, 28.2%, 24.5%, and 18.3% of excess risks of breast Methods: We identified NHB and NHW women with TNBC cancer mortality, overall mortality, and late-stage diagnosis in diagnosed from 2010 to 2015 and followed through 2016, using NHB (vs. NHW) patients were explained by residential segthe Surveillance, Epidemiology, and End Results dataset. County- regation. There was no significant association between resilevel racialized economic segregation was measured using the dential segregation and treatment. index of concentration at the extremes. Multilevel Cox regression Conclusions: Living in the most deprived versus privileged and multilevel logistic regression accounting for county-level neighborhoods was associated with lower likelihoods of early clustering were used to calculate HRs and ORs. detection and survival of patients with TNBC, contributing to Results: Of 25, 217 patients, 25.6% were NHB. Compared TNBC outcome disparities between NHBs and NHWs. with patients in counties with the highest concentration of Impact: This highlights the importance of breast cancer high-income NHW residents (most privileged), patients in screening for neighborhoods with predominantly low-income counties with the highest concentration of low-income NHB NHB residents and elucidating the pathways linking segregation residents (most deprived) had significantly higher risks of to TNBC prognosis.