Abstract 4236: Charlson comorbidity index scores before and after breast cancer diagnosis among a racially diverse cohort of women
Authors: Kaushiva Alpana , Hong Susan 
Published: August 2018

Abstract
Background: We examined racial/ethnic differences in Charlson comorbidity index scores (CCI) pre and post breast cancer (BC) diagnosis among Non-Hispanic White (NHW), Hispanic, and African-American (AA) women.
Methods: We conducted a retrospective chart review to calculate CCI scores (excluding age and BC) for 387 women diagnosed with BC between December 2013 and June 2017 at the University of Illinois Hospital and Health Sciences System. Using all available electronic records, we used International Chronic Disease 9 and 10 codes to determine presence or absence of a chronic condition pre and post BC diagnosis. Data was collected on race, ethnicity, stage, age at diagnosis, and vital status. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for associations between race/ethnicity and CCI among BC patients.
Results: Of the 387 BC patients, 63% were AA, 15% were Hispanic, and 16% were NHW. Mean ages were 56, 56, and 57 years, respectively. 217 women had a CCI of 0 (no comorbidity), 101 women had a CCI ≥1 at their BC diagnosis (mean CCI 4.8), and 69 women developed at least one chronic condition after their BC diagnosis (mean CCI 5.2; with a mean duration of follow-up of 1.9 years). AA women had a higher average CCI score compared to Hispanic and NHW women (CCI= 4.3 versus 3.9 & 3.3, p=0.006). Although not statistically significant, mean CCI scores were higher for Hispanic versus NHW women (CCI= 3.9 vs 3.3, p=0.08). At the time of their BC diagnosis, AA and Hispanic women were 2.2 times more likely to have a CCI ≥ 1 compared to NHW women [(AA vs NHW 95% CI (1.3-3.9), p=0.004); (Hispanic vs NHW 95% CI (1.1-4.3), p=0.02)]. Overall, compared to NHW women, AA women were 3.1 times more likely to have a cancer diagnosis other than breast [95% CI (1.1-8.9), p=0.04] and 5.4 times more likely to suffer from heart failure [95% CI (1.3-23.3), p=0.02]. Compared to NHW women, rates of diabetes were 2.3 times higher among AA women [95% CI (0.95-5.7), p=0.06] and 3.9 times higher among Hispanic women [95% CI (1.4-10.9), p=0.008].
Of the women with a CCI=0 at the time of their BC diagnosis, AA women were 3.3 times more likely [95% CI (1.3-8.1), p=0.01] and Hispanic women were 2.9 times more likely [95% CI (1.0-8.6), p=0.05] to go on to develop at least one chronic condition compared to NHW women. Additionally, of the women who died (n=16), AA and Hispanic women were diagnosed with BC at significantly younger mean ages compared to NHW women [(AA mean age=55 years; Hispanic mean age=64 years; NHW mean age=88 years; p=0.05)].
Conclusion: AA and Hispanic women enter their BC diagnosis with higher mean CCI scores and are more likely to develop ≥1 chronic health condition after their BC diagnosis. Our findings suggest that the burden of chronic disease both before and after BC diagnosis is greater for minority vs. NHW BC survivors. Future studies examining how this impacts survivorship for minority women are warranted.
Citation Format: Alpana Kaushiva, Susan Hong. Charlson comorbidity index scores before and after breast cancer diagnosis among a racially diverse cohort of women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4236.