Examining the race disparity in breast cancer mortality across Georgia
Abstract
Background: Despite similar incidence rates, nationwide breast cancer mortality is 40% higher among non-Hispanic Black (NHB) than non-Hispanic White (NHW) women. The race disparity is not evenly distributed throughout the US. Understanding geographic differences may provide additional insight into drivers of the disparity. However, current data are geographically limited, based primarily on death certificate information, do not incorporate incidence data, and often do not provide estimates for areas with small populations or sparse case data. We describe an approach to estimate the disparity in breast cancer mortality for all counties in Georgia that addresses these limitations.
Methods: NHB and NHW women aged ≥20 years diagnosed during 2005–2013 with a localized or regional first primary breast cancer were identified by the Georgia Cancer Registry. Race-specific standardized mortality ratios, indirectly adjusted for age, were computed for each county in Georgia (N=159). We employed a Bayesian spatial modeling framework, which stabilizes local estimates by borrowing information from neighboring counties, to estimate the race disparity for each county. Additionally, we estimated the effect of area-level covariates (rurality, poverty, education, housing, and racial composition) on the magnitude of the disparity.
Results: Overall, during the study period, 5-year breast cancer mortality was 43% higher among NHB than NHW women. The disparity varied across Georgia with more pronounced disparity observed in the central and southeast and less pronounced disparity in the southwest. The counties with the most pronounced disparity were Cobb (NHB vs NHW: 1.63), Chatham (1.61), Fulton (1.61), Putnam (1.55), Henry (1.51), and Toombs (1.51). Rurality increased and the proportion of owner-occupied housing decreased the magnitude of the disparity, but only after accounting for other area-level covariates.
Conclusions: We identified counties with a more pronounced disparity in breast cancer mortality. These data can be used to guide decision-making and resource allocation at the local level.
Keywords
Breast cancer, race disparity
Examining the race disparity in breast cancer mortality across Georgia
Background: Despite similar incidence rates, nationwide breast cancer mortality is 40% higher among non-Hispanic Black (NHB) than non-Hispanic White (NHW) women. The race disparity is not evenly distributed throughout the US. Understanding geographic differences may provide additional insight into drivers of the disparity. However, current data are geographically limited, based primarily on death certificate information, do not incorporate incidence data, and often do not provide estimates for areas with small populations or sparse case data. We describe an approach to estimate the disparity in breast cancer mortality for all counties in Georgia that addresses these limitations.
Methods: NHB and NHW women aged ≥20 years diagnosed during 2005–2013 with a localized or regional first primary breast cancer were identified by the Georgia Cancer Registry. Race-specific standardized mortality ratios, indirectly adjusted for age, were computed for each county in Georgia (N=159). We employed a Bayesian spatial modeling framework, which stabilizes local estimates by borrowing information from neighboring counties, to estimate the race disparity for each county. Additionally, we estimated the effect of area-level covariates (rurality, poverty, education, housing, and racial composition) on the magnitude of the disparity.
Results: Overall, during the study period, 5-year breast cancer mortality was 43% higher among NHB than NHW women. The disparity varied across Georgia with more pronounced disparity observed in the central and southeast and less pronounced disparity in the southwest. The counties with the most pronounced disparity were Cobb (NHB vs NHW: 1.63), Chatham (1.61), Fulton (1.61), Putnam (1.55), Henry (1.51), and Toombs (1.51). Rurality increased and the proportion of owner-occupied housing decreased the magnitude of the disparity, but only after accounting for other area-level covariates.
Conclusions: We identified counties with a more pronounced disparity in breast cancer mortality. These data can be used to guide decision-making and resource allocation at the local level.
