Abstract P4-03-27: The impact of Sociodemographic Disparities on Overall Survival of Adolescent and Young Adults (AYA) with Invasive Breast Cancer
Authors: Lopetegui-Lia Nerea , Jayakrishnan Thejus Thayyil , Barot Shimoli , Wei Wei , Kruse Megan L. 
Published: March 2023

Abstract
Background: Women of racial/ethnic minorities more often receive a diagnosis of advanced breast cancer (BC) at a younger age, and have higher morbidity, risk of recurrence and mortality. In addition to clinicopathologic and biological differences, sociodemographic factors may influence overall survival (OS) in these patients. BC care in AYA is particularly challenging and requires a multidisciplinary approach. In this National Cancer Database (NCDB) analysis, we aim to investigate various socioeconomic variables and their impact on survival in AYA patients with invasive BC. Methods: Using de-identified data accessed from the NCDB, we conducted a retrospective cohort analysis. Patients diagnosed with invasive BC between 2004-2019 and belonging to the age group of 15-39 years, defined as AYA, were included in the study. We performed an exploratory analysis and divided patients based on race/ethnicity, primary payer (government, private or uninsured), community median income (≤$40K, $40-50K, $50-63K, ≥$63K), residence area (metropolitan, rural or suburban) and high school degree achievement. Step-wise univariate regression models were used to analyse the impact of the relevant factors on overall survival. Survival estimates were calculated using the Kaplan Meier method. Results: We identified 18,018 AYA patients with invasive BC. Median age was 36 years, the median time from diagnosis to treatment was 25 days and the median follow-up was 82.9 months (range 0.1 - 207.1 months). The majority of patients were Caucasian (66%), followed by Black (14%), Hispanic (10%) and Asian (6%). 61% of Asian and 47% of Caucasians had an income of ≥$63,000, whereas only 31% of Hispanic patients and 26% of Black patients were in this income bracket. While Black patients constituted the majority of the lower income community (median income ≤$40K), Hispanics had the largest amount of patients without a high school degree (44%). Considering all patients, the 5-year OS was 92% (95% CI 0.91-0.92) for this study period. However, improved survival was observed in patients with private insurance versus government insurance (93% vs 84%, p &lt; 0.0001); patients with median income ≥$63,000 compared to &lt;$40,000 (94% vs 88%, p &lt; 0.0001); a lower percentage of no high school degree quartile &lt; 6.3% in contrast to ≥ 17.6% (95% vs 88%, p &lt; 0.0001); and lastly, patients living in a metropolitan area as opposed to suburban area (92% vs 89%, p &lt; 0.0001). Additional details are noted in Table 1. Conclusions: In our analysis we have found that AYA patients with invasive BC included in the NCDB have a variable OS that is impacted by demographic factors and socioeconomic status. Patients with private insurance, higher income, higher level of education and living in a metropolitan area had improved OS at 2 and 5 years. Understanding and narrowing the disparities in the care provided to AYA patients with invasive BC, particularly to those with sociodemographic disadvantages, could lead to improve outcomes.
Citation Format: Nerea Lopetegui-Lia, Thejus Thayyil Jayakrishnan, Shimoli Barot, Wei Wei, Megan L. Kruse. The impact of Sociodemographic Disparities on Overall Survival of Adolescent and Young Adults (AYA) with Invasive Breast Cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-03-27.