Breast Cancer Surgery Outcomes in Racial and Ethnic Minorities: Laying the Foundation for Targeted Prevention

Purpose: The purpose of this study is to investigate racial and socio-economic differences in hospital length of stay and mortality among hospitalized women undergoing breast cancer surgery.

Methods: We examined the association between race/ethnicity and socio-economic status with outcomes after breast conserving surgery or mastectomy among 71,156 women hospitalized with breast cancer using the Nationwide Inpatient Sample database from 2007 to 2011. Multivariable regression models were used to compute estimates and 95% confidence intervals (CI) for associations between race/ethnicity and residential income with hospital length of stay, and mortality adjusting for age, stage at diagnosis, insurance, and residential region.

Results: NH-Black women had more comorbidities, were more likely to reside in the lowest SES regions, and were more likely to have metastatic breast cancer compared with women in other racial/ethnic groups (all p-value <0.001). NH-Black women had significantly longer hospital stays (β=0.7, 95% CI:0.61-0.78), and were more likely to experience in-hospital mortality (OR=1.38, 95% CI:1.18-1.64) compared with NH-Whites. Patients residing in the highest SES regions were significantly less likely to experience in-hospital mortality (OR=0.77, 95% CI:0.64-0.93) compared with patients residing in the lowest SES regions after adjusting for confounders.

Conclusion: Among patients hospitalized for breast cancer, there are racial/ethnic and socio-economic differences in post-surgery outcomes. Further studies are needed to fully characterize if these differences are due to provider level or hospital level factors, and highlight areas for targeted approaches to eliminate these disparities.