Associations between social drivers of health and breast cancer stage at diagnosis among U.S. Black women

Abstract

U.S. Black women have disproportionately high breast cancer mortality, partly due to later-stage diagnoses. We examined how social drivers of health (SDOH) relate to stage at diagnosis by analyzing data from 4,995 breast cancer survivors in the Black Women's Health Study, Carolina Breast Cancer Study, and Women's Circle of Health Studies. SDOH were self-reported and stage was ascertained from medical records. We used polytomous logistic regression to estimate odds ratios (ORs) for diagnosis at stages III/IV or II versus stage I (referent), adjusting for age, insurance status, and income. Meta-analyzed results indicated that underutilization of screening mammography (OR = 3.21, 95% CI 1.90-5.43) and income below the federal poverty line (OR = 1.91, 95% CI 1.17-3.10) were significantly associated with later stage diagnosis (III/IV). ORs for lack of insurance and lower education were above 1.0, but not consistently statistically significant. These findings substantiate the importance of the affordability and utilization of breast cancer screening.

Fig. 1. Social drivers of health and stage at diagnosis by ER status.

Panels show the odds of breast cancer diagnosis at stage III or stage IV versus stage I by social drivers of health among ER+ breast cancer cases (a) and ER- breast cancer cases (b).

Fig. 2. Social drivers of health and stage at diagnosis by mammography utilization.

Panels show the odds of breast cancer diagnosis at stage III or stage IV versus stage I by social drivers of health among women old enough to be universally recommended screening mammography (a) and among women who utilized screening mammography (b).