Racial and Ethnic Variations in Pre-Diagnosis Comorbidity Burden and Health-Related Quality of Life Among Older Women with Breast Cancer

Eunkyung Lee; Robert B Hines; Jianbin Zhu; Eunji Nam; Michael J Rovito

doi:10.1007/s40615-023-01634-1

Racial and Ethnic Variations in Pre-Diagnosis Comorbidity Burden and Health-Related Quality of Life Among Older Women with Breast Cancer

J Racial Ethn Health Disparities. 2024 Jun;11(3):1587-1599. doi: 10.1007/s40615-023-01634-1. Epub 2023 May 23.

Authors

Eunkyung Lee¹, Robert B Hines², Jianbin Zhu^{3

4}, Eunji Nam⁵, Michael J Rovito⁶

Affiliations

¹ Department of Health Sciences, University of Central Florida College of Health Professions and Sciences, 4364 Scorpius Street, Orlando, Orlando, FL, USA. [email protected].
² Department of Population Health Sciences, University of Central Florida College of Medicine, FL, Orlando, USA.
³ Department of Statistics and Data Science, University of Central Florida College of Sciences, Orlando, FL, USA.
⁴ Research Institute, Advent Health, Orlando, FL, USA.
⁵ Department of Social Welfare, Incheon National University, Incheon, South Korea.
⁶ Department of Health Sciences, University of Central Florida College of Health Professions and Sciences, 4364 Scorpius Street, Orlando, Orlando, FL, USA.

PMID: 37219735
DOI: 10.1007/s40615-023-01634-1

Abstract

Background: This study examined racial/ethnic differences in comorbidity burden and health-related quality of life (HRQOL) among older women before breast cancer diagnosis.

Methods: From Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS) linked data resource, 2513 women diagnosed with breast cancer at ≥ 65 years between 1998 and 2012 were identified and grouped based on comorbidity burden using latent class analysis. Pre-diagnosis HRQOL was measured using SF-36/VR-12 and summarized to physical (PCS) and mental component summary (MCS) scores. The adjusted least-square means and 95% confidence intervals were obtained according to comorbidity burden and race/ethnicity. The interactions were examined with 2-way ANOVA.

Results: The latent class analysis revealed four comorbid burden classes, with Class 1 being the most healthy and Class 4 being the least healthy. African American (AA) and Hispanic women were more likely to be in Class 4 than non-Hispanic white (NHW) women (18.6%, 14.8%, and 8.3%, respectively). The mean PCS was 39.3 and differed by comorbidity burden and race/ethnicity (P_interaction < 0.001). There were no racial/ethnic differences in Classes 1 and 2, while NHW women reported significantly lower PCS scores than AA women in Classes 3 and 4. The mean MCS was 51.4 and differed by comorbidity burden and race/ethnicity (P_interaction < 0.001). There was no racial/ethnic difference in Class 3; however, AA women reported lower MCS scores than Asian/Pacific Islander women in Class 1, and AA and Hispanic women reported lower MCS scores than NHW women in Classes 2 and 4.

Conclusion: Comorbidity burden negatively affected HRQOL but differentially for racial/ethnic groups. As the comorbidity burden increases, NHW women are more concerned with physical HRQOL, while AA and Hispanic women are more concerned with mental HRQOL.

Keywords: Breast cancer; Comorbidity burden; Health-related quality of life; Latent class analysis; Racial variation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Black or African American / psychology
Black or African American / statistics & numerical data
Breast Neoplasms* / ethnology
Comorbidity*
Cost of Illness
Ethnicity* / psychology
Ethnicity* / statistics & numerical data
Female
Health Status Disparities
Hispanic or Latino / psychology
Hispanic or Latino / statistics & numerical data
Humans
Quality of Life*
Racial Groups / psychology
Racial Groups / statistics & numerical data
SEER Program
United States / epidemiology
White People* / psychology
White People* / statistics & numerical data