Abstract PR014: Racialized economic polarization effects on postoperative complications in patients with triple negative breast cancer
Authors: Chen J.C. , Elsaid Mohamed I. , Plascak Jesse J. , Stover Daniel G. , Carson William E. , Pawlik Timothy M. , Obeng-Gyasi Samilia 
Published: December 2023

Abstract
INTRODUCTION The physical separation of residential housing based on race and income, otherwise known as racialized economic residential segregation, has been associated with more aggressive tumor pathology and higher mortality in patients with breast cancer. The purpose of this study is to evaluate the impact of racialized economic segregation on post-operative complications (POC) in surgical patients with triple negative breast cancer (TNBC). METHODS Women aged 18+ diagnosed with stage I-III TNBC between 1/1/12-12/31/20 who underwent surgery were identified in the cancer registry and electronic medical record at a comprehensive cancer center. Racial (ICE-race) and racialized economic (ICE-race-income) polarization were operationalized using the Index of Concentration at the Extremes (ICE) at the census tract level. Metrics were divided into quartiles where higher quartiles represented greater polarization. Postoperative complications (POC) included technical, infectious, respiratory, urinary, and cardiovascular complications within 30 days of surgery. Crude and adjusted logistic regression generalized estimating equations (GEE) assessed the association between greater racial (ICE-race) and racialized economic (ICE-race-income) segregation as exposures and POC as the outcome, while accounting for clustering effects. Models were adjusted for age, race, ethnicity, health insurance, marital status, history of alcohol and smoking use, molecular subtype, clinical stage, receipt of chemotherapy, breast and axillary surgery type, and surgical reconstruction. RESULTS 626 patients were included in the study, of whom 509 (81.4%) identified as White, 97 (15.5%) Black, and 20 (3.2%) other. Median age was 59 (IQR 49.0, 67.0) years. Average overall frequency of POC was 8.2%, with increased odds in patients living in neighborhoods with greater racial segregation (ICE-race: Q1 4.0% vs. Q4 12.3%, P=0.02) and racialized economic segregation (ICE-race-income: Q1 3.2% vs. Q4 13.4%, P=0.001). Patients with TNBC living in neighborhoods with greater racialized economic segregation had a 2.52 (95% CI: 1.22 – 5.22) adjusted odds of POC compared to patients residing in less segregated neighborhoods. A one-quartile increase in racial segregation was associated with 41% increased odds of POC (aOR 1.41, 95% CI: 1.00 – 1.98). Similarly, a one-quartile increase in racialized economic polarization was associated with 45% increased odds of POC (aOR 1.45, 95% CI: 1.05 - 2.01). CONCLUSIONS Patients with TNBC breast cancer residing in areas with greater racial segregation or racialized economic segregation are more likely to experience postoperative complications than their counterparts in less segregated areas. Future studies need to examine the mechanistic pathways between neighborhood contextual factors and poor postoperative outcomes.
Citation Format: J.C. Chen, Mohamed I. Elsaid, Jesse J. Plascak, Daniel G. Stover, William E. Carson, Timothy M. Pawlik, Samilia Obeng-Gyasi. Racialized economic polarization effects on postoperative complications in patients with triple negative breast cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr PR014.