The impact of social drivers of health on delayed time to breast cancer surgery.
Academic Article
Overview
abstract
BACKGROUND: Timely surgical treatment is critical for optimal breast cancer (BC) outcomes, yet delays in care persist. This study examined associations between social drivers of health (SDOH), race/ethnicity, and delayed BC surgery in New York City, stratified by surgery type. METHODS: We conducted a retrospective analysis of BC cases diagnosed between 2007 and 2021 using INSIGHT Clinical Research Network data. Neighborhood-level SDOH, including household income, unemployment, percent of non-English speakers, and high school completion, were evaluated in relation to delayed surgery (>60 days from diagnosis). Multivariable logistic regression assessed associations between (1) SDOH and (2) race/ethnicity and delay of BC surgery, adjusting for confounders. RESULTS: Surgical delay occurred in 10.7% of lumpectomy and 25.3% of mastectomy patients. For lumpectomy, delays were more likely in neighborhoods with the highest non-English-speaking (OR = 1.37, 95%CI = 1.12-1.68) and higher unemployment quartiles (OR = 1.49, 95%CI = 1.22-1.82) and less likely in the highest income (OR = 0.69,95%CI = 0.56-0.84) and education quartiles (OR = 0.60, 95%CI = 0.49-0.74). Mastectomy showed similar patterns. Delays were more frequent among Non-Hispanic Black (lumpectomy OR = 2.23; mastectomy OR = 1.82) and Hispanic patients (OR = 1.64; OR = 1.39). CONCLUSION: This large, multi-institutional study reveals persistent disparities in timely surgical care. Nearly 15% experienced delays, with higher odds among Non-Hispanic Black, Hispanic, and socioeconomically disadvantaged patients, underscoring the need for equity-focused interventions.
