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Research article
Maria Elena Martinez
Corresponding Author
ORCiD: https://orcid.org/0000-0002-6728-1834
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This work is licensed under a CC BY 4.0 License. Read Full License
Purpose We assessed breast cancer mortality in older versus younger women according to race/ethnicity, neighborhood socioeconomic status (nSES), and health insurance status. Methods The study included female breast cancer cases 18 years of age and older, diagnosed between 2005 and 2015 in the California Cancer Registry. Multivariable Cox proportional hazards modeling was used to generate hazard ratios (HR) of breast cancer specific deaths and 95% confidence intervals (CI) for older (60+ years) versus younger (<60 years) patients separately by race/ethnicity, nSES, and health insurance status. Results Risk of dying from breast cancer was higher in older than younger patients after multivariable adjustment, which varied in magnitude by race/ethnicity (P-interaction<0.0001). Comparing older to younger patients, higher mortality differences were shown for non-Hispanic white (HR=1.43; 95% CI, 1.36-1.51) and Hispanic women (HR=1.37; 95% CI, 1.26-1.50) and lower differences for non-Hispanic blacks (HR=1.17; 95% CI, 1.04-1.31) and Asians/Pacific Islanders (HR=1.15; 95% CI, 1.02-1.31). HRs comparing older to younger patients varied by insurance status (P-interaction<0.0001), with largest mortality differences observed for privately insured women (HR=1.51; 95% CI, 1.43-1.59) and lowest in Medicaid/military/other public insurance (HR=1.18; 95% CI, 1.10-1.26). No age differences were shown for uninsured women. HRs comparing older to younger patients were similar across nSES strata. Conclusion Our results provide evidence for the continued disparity in black-white breast cancer mortality, which is magnified in younger women. Moreover, insurance status continues to play a role in breast cancer mortality, with uninsured women having the highest risk for breast cancer death, regardless of age.
Keywords
mortality, younger and older age, breast cancer
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View the published article at BMC Cancer.
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On 25 Feb, 2020
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Editorial decision: Minor revision
On 21 Feb, 2020
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On 20 Feb, 2020
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On 19 Feb, 2020
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On 19 Feb, 2020
No comments provided
Editorial decision: Minor revision
On 13 Feb, 2020
Reviewer #1 agreed
On 12 Feb, 2020
Review #1 received
Received 12 Feb, 2020
Reviewers invited
Invitations sent on 09 Feb, 2020
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On 22 Dec, 2019
Submission checks complete
On 21 Dec, 2019
Editor invited
On 21 Dec, 2019
No comments provided
Editorial decision: Major revision
On 22 Nov, 2019
Review #2 received
Received 18 Nov, 2019
Reviewer #3 agreed
On 18 Nov, 2019
Reviewer #2 agreed
On 11 Nov, 2019
Review #1 received
Received 27 Oct, 2019
Reviewer #1 agreed
On 10 Oct, 2019
Reviewers invited
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On 12 Aug, 2019
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On 23 Jul, 2019
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A new preprint design is coming!
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See the published version of this preprint at BMC Cancer.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Maria Elena Martinez
Corresponding Author
ORCiD: https://orcid.org/0000-0002-6728-1834
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Cancer.
Version 4
Posted 25 Feb, 2020
No community comments so far
Editorial decision: Accept
On 26 Feb, 2020
Editor assigned
On 25 Feb, 2020
Submission checks complete
On 24 Feb, 2020
Editor invited
On 24 Feb, 2020
No comments provided
Editorial decision: Minor revision
On 21 Feb, 2020
Editor assigned
On 20 Feb, 2020
Submission checks complete
On 19 Feb, 2020
Editor invited
On 19 Feb, 2020
No comments provided
Editorial decision: Minor revision
On 13 Feb, 2020
Reviewer #1 agreed
On 12 Feb, 2020
Review #1 received
Received 12 Feb, 2020
Reviewers invited
Invitations sent on 09 Feb, 2020
Editor assigned
On 22 Dec, 2019
Submission checks complete
On 21 Dec, 2019
Editor invited
On 21 Dec, 2019
No comments provided
Editorial decision: Major revision
On 22 Nov, 2019
Review #2 received
Received 18 Nov, 2019
Reviewer #3 agreed
On 18 Nov, 2019
Reviewer #2 agreed
On 11 Nov, 2019
Review #1 received
Received 27 Oct, 2019
Reviewer #1 agreed
On 10 Oct, 2019
Reviewers invited
Invitations sent on 16 Sep, 2019
Editor assigned
On 12 Aug, 2019
Submission checks complete
On 23 Jul, 2019
Editor invited
On 23 Jul, 2019
First submitted
On 02 Jul, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Cancer.
Purpose We assessed breast cancer mortality in older versus younger women according to race/ethnicity, neighborhood socioeconomic status (nSES), and health insurance status. Methods The study included female breast cancer cases 18 years of age and older, diagnosed between 2005 and 2015 in the California Cancer Registry. Multivariable Cox proportional hazards modeling was used to generate hazard ratios (HR) of breast cancer specific deaths and 95% confidence intervals (CI) for older (60+ years) versus younger (<60 years) patients separately by race/ethnicity, nSES, and health insurance status. Results Risk of dying from breast cancer was higher in older than younger patients after multivariable adjustment, which varied in magnitude by race/ethnicity (P-interaction<0.0001). Comparing older to younger patients, higher mortality differences were shown for non-Hispanic white (HR=1.43; 95% CI, 1.36-1.51) and Hispanic women (HR=1.37; 95% CI, 1.26-1.50) and lower differences for non-Hispanic blacks (HR=1.17; 95% CI, 1.04-1.31) and Asians/Pacific Islanders (HR=1.15; 95% CI, 1.02-1.31). HRs comparing older to younger patients varied by insurance status (P-interaction<0.0001), with largest mortality differences observed for privately insured women (HR=1.51; 95% CI, 1.43-1.59) and lowest in Medicaid/military/other public insurance (HR=1.18; 95% CI, 1.10-1.26). No age differences were shown for uninsured women. HRs comparing older to younger patients were similar across nSES strata. Conclusion Our results provide evidence for the continued disparity in black-white breast cancer mortality, which is magnified in younger women. Moreover, insurance status continues to play a role in breast cancer mortality, with uninsured women having the highest risk for breast cancer death, regardless of age.
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