Background Inequities in guideline-concordant treatment receipt contribute to worse survival in Black breast cancer (BCa) patients. Inequity-reduction interventions (eg, navigation, bias training, tracking dashboards) can close such treatment gaps. We simulated the population-level impact of statewide implementation of inequity-reduction interventions on racial BCa inequities in North Carolina. Methods Using registry-linked multi-payer claims data, we calculated Black/White inequities in endocrine (ET; n = 12,033) and chemotherapy (CTx; n = 1,819) receipt. We then built cohort- (ET and CTx), and race-stratified Markov models to simulate the potential increase in the proportion of patients receiving ET or CTx and subsequent improvements in BCa outcomes if inequity-reducing intervention were implemented statewide. We report uncertainty bounds representing 95% of simulation results. Results 75.6% and 72.1% of Black patients received ET and CTx over the 2006-2015 and 2004-2015 periods (vs 79.3 and 78.9% of White patients, respectively). Inequity-reduction interventions could increase ET and CTx receipt among Black patients to 89.9% (85.3, 94.6%) and 85.7% (80.7, 90.9%). Such interventions could also decrease 5-and 10-year BCa mortality gaps from 3.4 to 3.2 (3.0, 3.3) and from 6.7 to 6.1 (5.9, 6.4) percentage points in the ET cohorts and from 8.6 to 8.1 (7.7, 8.4) and from 8.2 to 7.8 (7.3, 8.1) percentage points in the CTx cohorts. Conclusions Inequity-focused interventions could improve cancer outcomes for Black patients. However, they would not fully close the racial BCa mortality gap. Addressing other inequities along cancer continuum (eg, screening, pre-and post-diagnosis risk factors) is required to achieve full equity in BCa outcomes.

中文翻译：

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模拟减少乳腺癌治疗种族差距的干预措施对人口的影响

背景 符合指南的治疗接受方面的不平等导致黑人乳腺癌 (BCa) 患者的生存率较差。减少不平等的干预措施（例如导航、偏见培训、跟踪仪表板）可以缩小这种治疗差距。我们模拟了全州范围内实施减少不平等干预措施对北卡罗来纳州BCA种族不平等的人口层面影响。方法 使用登记相关的多付款人索赔数据，我们计算了内分泌（ET；n = 12,033）和化疗（CTx；n = 1,819）收据方面的黑人/白人不平等。然后，我们建立了队列（ET 和 CTx）和种族分层马尔可夫模型，以模拟如果在全州范围内实施减少不平等的干预措施，接受 ET 或 CTx 的患者比例的潜在增加以及 BCa 结果的后续改善。我们报告了代表 95% 模拟结果的不确定性界限。结果 2006-2015 年和 2004-2015 年期间，75.6% 和 72.1% 的黑人患者接受了 ET 和 CTx（白人患者分别为 79.3% 和 78.9%）。减少不平等干预措施可以将黑人患者接受 ET 和 CTx 的比例提高至 89.9%（85.3，94.6%）和 85.7%（80.7，90.9%）。此类干预措施还可以将 ET 队列的 5 年和 10 年 BCa 死亡率差距从 3.4 个百分点减少到 3.2 个百分点（3.0, 3.3），从 6.7 个百分点减少到 6.1 个百分点（5.9, 6.4），从 8.6 个百分点减少到 8.1 个百分点（7.7, 8.4）， CTx 队列中的百分比从 8.2 提高到 7.8 (7.3, 8.1) 个百分点。结论 以不平等为重点的干预措施可以改善黑人患者的癌症结果。然而，他们不会完全缩小种族 BCa 死亡率差距。要实现 BCa 结果的完全公平，需要解决癌症连续体中的其他不平等问题（例如筛查、诊断前和诊断后风险因素）。