Abstract 3672: Area-level drivers of the breast cancer mortality race disparity in Georgia
Authors: Nash Rebecca , Collin Lindsay J. , Switchenko Jeffrey , McCullough Lauren E. 
Published: June 2022

Abstract
In the US, breast cancer mortality is 40% greater among Black than White women. The mortality disparity varies geographically and has persisted despite improvements in survival. Georgia is one of six states where breast cancer recently surpassed lung cancer as the leading cause of cancer death among Black but not White women, is a large and diverse state, and thus, an ideal setting to study race disparities. Our work in the Atlanta Metro area has shown that the mortality disparity is pronounced among patients with clinically favorable subtypes, low Oncotype DX® recurrence scores, guideline-concordant care, and similar access to surgical facilities. The disparity also persists among patients with private insurance and those living in areas of low poverty, suggesting clinical and sociodemographic differences do not fully account for the observed disparity. Recent evidence suggests area-level factors may contribute to the disparity. Our group reported that neighborhood-level redlining (i.e., mortgage denial based on place) is associated with an increase in breast cancer mortality while neighborhood-level lending bias (i.e., mortgage denial based on race) is associated with a decrease in breast cancer mortality. In Atlanta, Black patients are more likely to live in redlined areas and less likely to live in areas with lending bias, than White patients, further suggesting place is an important driver of disparities. We investigated the role of other area-level factors on race-specific mortality in Georgia. Race-specific standardized mortality ratios were computed for each county in Georgia. Observed breast cancer deaths among non-Hispanic White (NHW) and non-Hispanic Black (NHB) women within 5 years of a stage I-III breast cancer diagnosis (2005-2013) were obtained from the Georgia Cancer Registry. County-level characteristics were derived from the American Community Survey and Georgia Department of Public Health. A Bayesian model-based approach was used to stabilize local estimates and estimate associations with area-level factors. Smoothed estimates of relative disparity ranged from 1.2 to 1.7, with pronounced disparity for counties surrounding the Atlanta and Savannah metropolitan areas and least pronounced disparity in Metro Albany counties. Among NHB women, living in a rural (versus non-rural) county was associated with a nearly 20% increase in breast cancer mortality (RR=1.19, 95% credible interval (CI): 0.96, 1.48); an association not observed in NHW patients (RR=0.93, 95% CI: 0.79, 1.07). In contrast, a 10-point increase in the percent of adults with ≤high school education was associated with a 10% increase (95% CI: 1.05, 1.17) in mortality for NHW patients only. The race disparity in Georgia is not evenly distributed across counties. We identified area-level characteristics associated with race-specific mortality. Identifying other area-level drivers of breast cancer mortality is an important area of inquiry.
Citation Format: Rebecca Nash, Lindsay J. Collin, Jeffrey Switchenko, Lauren E. McCullough. Area-level drivers of the breast cancer mortality race disparity in Georgia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3672.