Abstract P4-14-03: Household net worth is associated with racial disparities in hormonal therapy adherence among women with early stage breast cancer
Authors: Hershman Dawn L , Tsui Jennifer , Wright Jason D , Coromilas Ellie J , Tsai Wei Yann , Neugut Alfred I 
Published: May 2015

Abstract
Background: Non-adherence to adjuvant hormonal therapy is common and has been associated with both increased copayment amount and black race. Studies suggest controlling for wealth may eliminate racial disparities for a variety of medical condition. We investigated the impact of personal finance on disparities in adherence rates.
Patients and Methods: Using de-identified, integrated pharmacy and medical claims data from the Optum insurance claims database, we identified women &gt;50 years old on hormonal therapy for early breast cancer with at least 2 mail order prescription refills between 1/1/07 and 12/31/11. Variables evaluated included demographic and clinical information, annual household income, estimated household net worth (&lt;$250,000, $250,000-750,000, &gt;$750,000), insurance type, and monthly copayment amounts (&lt;$10, $10-20, &gt;$20). Non-adherence was defined as a medication possession ratio &lt;80% of eligible days during a 2-year period. Logistic regression analyses were conducted by sequentially including sociodemographic variables, copayment amount, and each of the economic variables. Due to the strong correlation between net worth and income, and variance of income with age, net worth was included in multivariate models; an additional analysis was done stratifying patients by net worth.
Results: We identified 15,522 subjects who initiated hormonal therapy; 25% were non-adherent during the study period. Adherence was 67% with net worth &lt;$25,000 and 81% with net worth &gt;$750,000 (p&lt;0.001). In a univariate analysis, adherence was negatively associated with black race (OR 0.76, p&lt;0.001), advanced age, comorbidity, extent of surgery, Medicare insurance, and higher copayment. Adherence was positively associated with higher household income (OR 1.3, p&lt;0.001) compared to lowest income and with medium net worth (OR=1.26, p&lt;0.001) and higher net worth (OR 1.5, p&lt;0.001) compared to the lowest net worth group. The negative association of black race and adherence (OR 0.76) was reduced by the sequential addition of sociodemographic variables (OR 0.78, p&lt;0.001), copayment (OR 0.80, p=0.004), and net worth (0.87, p=0.08). In the analysis stratified by net worth, black race was no longer associated with decreased adherence. In patients within the high net worth category, high copayment amount was also no longer associated with decreased adherence (OR 1.0, p=0.77).
Conclusions: We have shown that financial factors, and in particular net worth, partially explain the lower hormone therapy adherence rate in black women compared to white women. These results suggest economic factors may contribute significantly to disparities in the quality of breast cancer care.
Citation Format: Dawn L Hershman, Jennifer Tsui, Jason D Wright, Ellie J Coromilas, Wei Yann Tsai, Alfred I Neugut. Household net worth is associated with racial disparities in hormonal therapy adherence among women with early stage breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-14-03.