Background: We assessed breast cancer mortality in older versus younger women according to race/ethnicity,\nneighborhood socioeconomic status (nSES), and health insurance status.\nMethods: The study included female breast cancer cases 18 years of age and older, diagnosed between 2005 and\n2015 in the California Cancer Registry. Multivariable Cox proportional hazards modeling was used to generate\nhazard ratios (HR) of breast cancer specific deaths and 95% confidence intervals (CI) for older (60+ years) versus\nyounger (< 60 years) patients separately by race/ethnicity, nSES, and health insurance status.\nResults: Risk of dying from breast cancer was higher in older than younger patients after multivariable adjustment,\nwhich varied in magnitude by race/ethnicity (P-interaction< 0.0001). Comparing older to younger patients, higher\nmortality differences were shown for non-Hispanic White (HR = 1.43; 95% CI, 1.36â??1.51) and Hispanic women (HR =\n1.37; 95% CI, 1.26â??1.50) and lower differences for non-Hispanic Blacks (HR = 1.17; 95% CI, 1.04â??1.31) and Asians/\nPacific Islanders (HR = 1.15; 95% CI, 1.02â??1.31). HRs comparing older to younger patients varied by insurance status\n(P-interaction< 0.0001), with largest mortality differences observed for privately insured women (HR = 1.51; 95% CI,\n1.43â??1.59) and lowest in Medicaid/military/other public insurance (HR = 1.18; 95% CI, 1.10â??1.26). No age differences\nwere shown for uninsured women. HRs comparing older to younger patients were similar across nSES strata.\nConclusion: Our results provide evidence for the continued disparity in Black-White breast cancer mortality, which\nis magnified in younger women. Moreover, insurance status continues to play a role in breast cancer mortality, with\nuninsured women having the highest risk for breast cancer death, regardless of age.
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