Trends in survival disparity following breast cancer diagnosis by health insurance coverage and race in the US.

218 Background: Women racialized as Black have higher breast cancer mortality rates than women racialized as White, despite lower breast cancer incidence rates. Ongoing advances in effective cancer screening and treatment modalities have translated into a higher proportion of early-stage cancer diagnoses and improvements in survival. However, many new treatments are costly and people from low-income households and/or without health insurance might not be able to afford them, potentially widening existing disparities. This study assessed trends in breast survival disparities by health insurance coverage and race in the US. Methods: We identified 1 009 479 women aged 18-64 years newly diagnosed with breast cancer during 2004-2022 from the National Cancer Database. Cox proportional hazard models were used to compare survival after cancer diagnosis over time by health insurance status and race (private-non-Hispanic White (NHW), Medicaid-NHW, uninsured-NHW, private-non-Hispanic Black (NHB), Medicaid-NHB, and uninsured-NHB), controlling for sociodemographic characteristics, including zip code-level median income. Results: Compared to women racialized as NHW with private insurance at diagnosis, worse survival was observed for all other groups in each time frame; with survival disparities widening over time for uninsured-NHW and uninsured-NHB groups (both P-trend < .05). Conclusions: Survival disparities by health insurance among both NHW and NHB individuals newly diagnosed with cancer widened over time, while the racial disparity remained stable among those with insurance. Having health insurance may mitigate racial disparities in survival. Trends in survival disparity by health insurance and race among women with breast cancer. 2004-2009 2010-2015 2016-2022 P-trend Adjusted Hazard ratios* Private-NHB 1.90(1.84-1.97) 1.71(1.65-1.78) 1.79(1.71-1.86) 0.009 Medicaid-NHW 2.76(2.66-2.87) 2.72(2.63-2.82) 2.80(2.69-2.92) 0.634 Medicaid-NHB 3.71(3.54-3.90) 3.43(3.28-3.59) 3.65(3.47-3.84) 0.604 Uninsured-NHW 3.13(2.97-3.31) 3.17(2.99-3.36) 4.05(3.75-4.38) <.0001 Uninsured-NHB 4.10(3.81-4.41) 4.33(4.02-4.65) 5.87(5.35-6.43) <.0001 *Private-NHW as the reference.