Abstract A092: Investigating the relationships between neighborhood characteristics, race, and guideline concordant care among women diagnosed with breast cancer

Abstract Background: The neighborhood in which individuals reside has a direct impact on access to care for cancer patients; however, little is known regarding the role of the neighborhood environment in receipt of guideline care among breast cancer patients. Moreover, whether this relationship differs for White compared with Black patients, who are more likely to live in deprived neighborhoods and experience increased risk of breast cancer mortality, is not well understood. In this study, we estimated the effect of neighborhood deprivation index (NDI) and rurality on receipt of guideline-concordant care (GCC) among breast cancer patients overall and by race. Methods: Using the Georgia Cancer Registry, we identified 30,144 women diagnosed with a stage I–III first primary breast cancer in Georgia (2011–2017) who had received surgery and had available information on breast tumor characteristics. NDI was derived via principal component analysis of 2011-2015 block group-level American Community Survey data on poverty, housing, income, unemployment, occupation, and education. County-level rurality was measured using data from the Georgia Department of Public Health. Receipt of recommended therapies (chemo-, radiation, endocrine, and anti-HER2 therapies) as indicated based on NCCN guidelines was considered GCC. We used logistic regression to compute the odds ratios (ORs) and 95% confidence intervals (CIs) between quintiles of NDI or rurality and receipt of GCC overall and among non-Hispanic Black (NHB) and non-Hispanic White (NHW) breast cancer patients. Results: Our cohort included 9,119 (30%) NHB and 21,025 (70%) NHW women. Approximately 24% of the cohort resided in a rural county. Overall, 58% received GCC, with 59% of those residing in the most deprived neighborhoods (NDI quintile (Q) 5) receiving GCC and 60% of those residing in the least deprived neighborhoods (NDI Q1) receiving GCC. Overall, in age-adjusted models, quintiles of NDI were not associated with receipt of GCC (Q5 vs. Q1 OR=1.03, 95%CI: 0.95, 1.11). This association did not appreciably change after adjustment for race, breast tumor characteristics, sociodemographic factors, and rurality. NDI remained unassociated with receipt of GCC among NHB (Q5 vs Q1: OR=0.98, 95% CI 0.82, 1.18) and NHW (Q5 vs. Q1: OR=0.89, 95% CI 0.78, 1.02) patients. Compared with living in an urban neighborhood, living in a rural neighborhood was associated with a 21% (OR=1.21, 95% CI 1.13, 1.29) increased odds of not receiving GCC. This association was stronger among NHB (1.39, 95% CI 1.22, 1.59) compared with NHW (OR=1.13, 95% CI 1.04, 1.22) women. Conclusion: In this study, living in a rural neighborhood was associated with not receiving GCC, particularly among NHB women. Neighborhood deprivation was not associated with GCC, overall or by race. More research is needed to understand if other neighborhood characteristics beyond neighborhood deprivation and rurality influence receipt of guideline care, particularly for Black breast cancer patients, who are more likely to encounter harmful neighborhood exposures. Citation Format: Lauren E. Barber, Lauren E. McCullough, Maret L. Maliniak, Tsion A. Armidie, Alexis J. Smith, Lindsay J. Collin. Investigating the relationships between neighborhood characteristics, race, and guideline concordant care among women diagnosed with breast cancer [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr A092.