Assessing the Impact of Socio-economic Variables on Breast Cancer Treatment Outcome Disparity

Abstract

<b>Background:</b> We studied Surveillance, Epidemiology and End Results (SEER) breast cancer data of GeorgiaUSA to analyze the impact of socio-economic factors on the disparity of breast cancer treatment outcome. Materialsand <br/><b>Methods</b>: This study explored socio-economic, staging and treatment factors that were available in the SEERdatabase for breast cancer from Georgia registry diagnosed in 2004-2009. An area under the receiver operatingcharacteristic curve (ROC) was computed for each predictor to measure its discriminatory power. The bestbiological predictors were selected to be analyzed with socio-economic factors. Survival analysis, Kolmogorov-Smirnov 2-sample tests and Cox proportional hazard modeling were used for univariate and multivariate analysesof time to breast cancer specific survival data. <br/><b>Results</b>: There were 34,671 patients included in this study, 99.3%being females with breast cancer. This study identified race and education attainment of county of residenceas predictors of poor outcome. On multivariate analysis, these socio-economic factors remained independentlyprognostic. Overall, race and education status of the place of residence predicted up to 10% decrease in causespecific survival at 5 years. <br/><b>Conclusions</b>: Socio-economic factors are important determinants of breast canceroutcome and ensuring access to breast cancer treatment may eliminate disparities.