Purpose To estimate the contribution of differences in demographics, comorbidity, insurance, tumor characteristics, and treatment to the overall mortality disparity between nonelderly black and white women diagnosed with early-stage breast cancer. Patients and Methods Excess relative risk of all-cause death in black versus white women diagnosed with stage I to III breast cancer, expressed as a percentage and stratified by hormone receptor status for each variable (demographics, comorbidity, insurance, tumor characteristics, and treatment) in sequentially, propensity-scored, optimally matched patients by using multivariable hazard ratios (HRs). Results We identified 563,497 white and black women 18 to 64 years of age diagnosed with stage I to III breast cancer from 2004 to 2013 in the National Cancer Data Base. Among women with hormone receptor-positive disease, who represented 78.5% of all patients, the HR for death in black versus white women in the demographics-matched model was 2.05 (95% CI, 1.94 to 2.17). The HR decreased to 1.93 (95% CI, 1.83 to 2.04), 1.54 (95% CI, 1.47 to 1.62), 1.30 (95% CI, 1.24 to 1.36), and 1.25 (95% CI, 1.19 to 1.31) when sequentially matched for comorbidity, insurance, tumor characteristics, and treatment, respectively. These factors combined accounted for 76.3% of the total excess risk of death in black patients; insurance accounted for 37.0% of the total excess, followed by tumor characteristics (23.2%), comorbidities (11.3%), and treatment (4.8%). Results generally were similar among women with hormone receptor-negative disease, although the HRs were substantially smaller. Conclusion Matching by insurance explained one third of the excess risk of death among nonelderly black versus white women diagnosed with early-stage breast cancer; matching by tumor characteristics explained approximately one fifth of the excess risk. Efforts to focus on equalization of access to care could substantially reduce ethnic/racial disparities in overall survival among nonelderly women diagnosed with breast cancer.

中文翻译：

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导致 2004 年至 2013 年非老年乳腺癌女性生存率黑白差异的因素

目的 评估人口统计学、合并症、保险、肿瘤特征和治疗的差异对诊断为早期乳腺癌的非老年黑人和白人女性总体死亡率差异的贡献。患者和方法 诊断为 I 至 III 期乳腺癌的黑人与白人女性的全因死亡相对风险过高，以百分比表示，并按每个变量（人口统计学、合并症、保险、肿瘤特征和治疗）的激素受体状态分层) 通过使用多变量风险比 (HRs) 在顺序、倾向评分、最佳匹配的患者中进行。结果 我们在 2004 年至 2013 年期间在国家癌症数据库中确定了 563,497 名 18 至 64 岁的白人和黑人女性，这些女性被诊断为 I 至 III 期乳腺癌。在占所有患者 78.5% 的激素受体阳性疾病女性中，人口统计学匹配模型中黑人与白人女性的死亡 HR 为 2.05（95% CI，1.94 至 2.17）。HR 依次降低至 1.93（95% CI，1.83 至 2.04）、1.54（95% CI，1.47 至 1.62）、1.30（95% CI，1.24 至 1.36）和 1.25（95% CI，1.119 至 1）。分别与合并症、保险、肿瘤特征和治疗相匹配。这些因素加起来占黑人患者死亡总超额风险的 76.3%；保险占总超额的 37.0%，其次是肿瘤特征 (23.2%)、合并症 (11.3%) 和治疗 (4.8%)。结果在患有激素受体阴性疾病的女性中大致相似，尽管 HR 小得多。结论 保险匹配解释了诊断为早期乳腺癌的非老年黑人女性与白人女性死亡风险增加的三分之一；肿瘤特征匹配解释了大约五分之一的过度风险。专注于获得医疗服务的平等化的努力可以大大减少被诊断患有乳腺癌的非老年妇女在总体生存率方面的种族/种族差异。