Economic disparities in Appalachia linked to risk factors for long-term health for estrogen positive breast cancer patients

Elsevier, Cancer Treatment and Research Communications, Volume 19, 1 January 2019
Roberson P.N.E., Miller M., Lloyd J., Bell C., Eric Heidel R., Bell J.
Background: Breast cancer is the second leading cause of cancer death for women in the United States and mortality from cancer is more common among individuals in the Appalachian region compared to the rest of the country. We examined how risk factors for long-term health outcomes for Estrogen positive breast cancer patients differed by county economic status in southern Appalachia. Methods: Data was collected through retrospective data mining of patient medical files (N = 238). Using the self-reported zipcode, patients were classified into county economic status. At-risk and distressed designations were also rural counties. Bi-variate statistical analyses were used to evaluate how demographic, behavioral, health risk factors differed across economic statuses. Results: For demographic factors, fewer single individuals lived in at-risk counties and older individuals lived in distressed counties. For health behaviors, more individuals in transitional counties report drinking alcohol but more individuals in distressed counties reported adhering to medication. For morbidity, more individuals in distressed counties reported having diabetes or a circulatory disease. Conclusions: Many risk factors differed across county economic statuses. Therefore, doctors must consider the patient's context as a risk factor not just their individual characteristics. Patients from economically distressed counties may be at higher risk for treatment complications due to a larger proportion of co-morbidities and older age. Because many risk factors (eg, previous cancer, BMI) are similarly proportioned across Appalachian economic statuses, ER+ breast cancer patients in Appalachia may be at a similarly high risk for health complications compared to the rest of the country.