Wallner LP, Chen LH, Hogan TA, Brasfield FM, Haque R. The influence of medical comorbidities on survival disparities in a multi-ethnic group of patients with de novo metastatic breast cancer.
Cancer Epidemiol Biomarkers Prev 2022;
31:1935-1943. [PMID:
35861620 DOI:
10.1158/1055-9965.epi-22-0065]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/08/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND
The influence of common medical comorbidities on mortality and racial/ethnic disparities in mortality among women with metastatic breast cancer remains largely unknown.
METHODS
In this longitudinal study, women with newly diagnosed stage IV breast cancer were identified in a large, diverse, integrated healthcare delivery system from January 2009 to December 2017 (n=995) and followed through December 31, 2018 for all-cause and breast cancer-specific mortality via electronic health records. We computed mortality rates by race/ethnicity and Elixhauser comorbidity index (ECI). Multivariable-adjusted hazard ratios (HR) assessing the influence of race/ethnicity and comorbidity status on overall and breast-cancer specific mortality were estimated using proportional hazards regression adjusted for age, breast cancer subtype, geocoded income, and palliative cancer treatments.
RESULTS
Nearly 17% of this cohort had diabetes and 45% had hypertension. Overall, 644 deaths occurred (median follow-up time of 1.8 years), of which 88% were breast cancer related. The risk of overall mortality was increased in Asian/PI (adjusted HR=1.45, 95% CI: 1.10-1.92) and African American/Black women (adjusted HR=1.34, 95% CI: 1.02-1.76) when compared to white women. Women with more comorbidities (ECI>5) had more than three-fold higher overall mortality rate than those without any comorbidities (602/1000 PY vs. 175/1,000 PY). Similar associations were found for breast cancer-specific mortality.
CONCLUSIONS
Medical comorbidities are associated with an increased risk of overall mortality among women with de novo metastatic disease and may influence racial/ethnic disparities in mortality.
IMPACT
Optimizing the management of medical comorbidities in metastatic breast cancer patients may help reduce disparities in breast-cancer related mortality.
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