Association of Neighborhood Deprivation with Stage at Diagnosis and Treatment Delay for Breast Cancer in Philadelphia.

Abstract

Introduction: Neighborhood deprivation and other sociodemographic factors are associated with breast cancer outcomes, but in Philadelphia, the country's poorest large city, these factors have been understudied. We examined their association with stage at breast cancer diagnosis and treatment delay (>60 days after diagnosis).

Methods: We identified women aged ≥18 years with breast cancer at an academic health system based in Philadelphia from 2011 to 2019. The Area Deprivation Index (ADI) was calculated across the cohort and grouped into quartiles: ADI 1 = least deprived, ADI 4 = most deprived. Multivariable logistic regression estimated sociodemographic associations with advanced stage (III-IV) at diagnosis and treatment delay.

Results: Overall, 11,108 patients were identified. White patients constituted a larger proportion of the least versus most deprived group (ADI 1 = 84.4% vs. ADI 4 = 50.9%), while the proportion of Black patients was highest in the most deprived group (ADI 1 = 3.9% vs. ADI 4 = 41.5%). Patients in the ADI 4 group (vs. ADI 1; odds ratio [OR] 1.48, 95% confidence interval [CI] 1.19-1.84), who identified as Black (vs. White; OR 1.35, 95% CI 1.11-1.63), and with Medicaid insurance (OR 1.94, 95% CI 1.51-2.49) or no insurance (OR 2.21, 95% CI 1.27-3.67) versus privately insured patients had higher odds of presenting with advanced stage (all p < 0.05). Patients who identified as Asian, had Medicaid insurance or no insurance, were >70 years of age, and presented with advanced stage were less likely to receive treatment within 60 days, while patients in the ADI 2-4 group were twice as likely to receive treatment within 60 days as patients in the ADI 1 group.

Conclusions: Neighborhood deprivation was associated with advanced stage at presentation, but not treatment delay, for patients with breast cancer in the Philadelphia metropolitan area, suggesting neighborhood-level opportunities to facilitate screening and more early-stage diagnoses.