Epidemiology

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Hypertension is an independent predictor of survival disparity between African-American and white breast cancer patients

  1. Dejana Braithwaite1,†,*,
  2. C. Martin Tammemagi2,
  3. Dan H. Moore3,
  4. Elissa M. Ozanne4,
  5. Robert A. Hiatt3,
  6. Jeff Belkora1,
  7. Dee W. West5,
  8. William A. Satariano6,
  9. Michael Liebman7,
  10. Laura Esserman1

Article first published online: 9 OCT 2008

DOI: 10.1002/ijc.24054

Issue

International Journal of Cancer

International Journal of Cancer

Volume 124, Issue 5, pages 1213–1219, 1 March 2009

Additional Information

How to Cite

Braithwaite, D., Tammemagi, C. M., Moore, D. H., Ozanne, E. M., Hiatt, R. A., Belkora, J., West, D. W., Satariano, W. A., Liebman, M. and Esserman, L. (2009), Hypertension is an independent predictor of survival disparity between African-American and white breast cancer patients. Int. J. Cancer, 124: 1213–1219. doi: 10.1002/ijc.24054

Author Information

  1. 1

    Department of Surgery, Carol Franc Buck Breast Care Center, University of California, San Francisco, CA

  2. 2

    Department of Community Health Sciences, Brock University, Ontario, Canada

  3. 3

    Department of Epidemiology and Biostatistics, University of California, San Francisco, CA

  4. 4

    Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA

  5. 5

    Northern California Cancer Center, Fremont, CA

  6. 6

    School of Public Health, University of California, Berkeley, CA

  7. 7

    Windber Research Institute, Windber, PA

  1. †

    Fax: 415/514-8150.

*Department of Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 185 Berry Street, Lobby 4, Suite 5700, San Francisco, CA 94107

Publication History

  1. Issue published online: 18 DEC 2008
  2. Article first published online: 9 OCT 2008
  3. Accepted manuscript online: 9 OCT 2008 12:00AM EST
  4. Manuscript Accepted: 10 SEP 2008
  5. Manuscript Received: 29 MAY 2008

Funded by

  • US Department of Defense (Center of Excellence in Breast Cancer Care). Grant Number: DAMD17-03-1-0481
  • Kaiser Permanente Community Services Program and the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute. Grant Number: N01-CN-05224
  • Windber Research Institute

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Keywords:

  • comorbidity;
  • breast cancer;
  • survival;
  • race/ethnicity;
  • cohort

Abstract

The objective of this study was to determine whether comorbidity, or pre-existing conditions, can account for some of the disparity in survival between African-American and white breast cancer patients. A historical cohort study was conducted of 416 African-American and 838 white women diagnosed with breast cancer between 1973 and 1986, and followed through 1999 in the Kaiser Permanente Northern California Medical Care Program. Information on comorbidity, tumor characteristics and breast cancer treatment was obtained from medical records, and Surveillance, Epidemiology and End Results, Northern California Cancer Center Registry. Associations between comorbidity and survival were analyzed with multiple Cox proportional hazards regression. Over a mean follow-up of 9 years, African Americans had higher overall crude mortality than whites: 165 (39.7%) versus 279 (33.3%), respectively. When age, race, tumor characteristics and breast cancer treatment were controlled, the presence of hypertension was associated with all cause survival [hazard ratio (HR) = 1.33, 95% confidence intervals (CI) 1.07–1.67] and it accounted for 30% of racial disparity in this outcome. Hypertension-augmented Charlson Comorbidity Index was a significant predictor of survival from all causes (HR = 1.32, 95%CI 1.18–1.49), competing causes (HR = 1.52, 95%CI 1.32–1.76) and breast cancer specific causes (HR = 1.18, 95%CI 1.03–1.35). In conclusion, hypertension has prognostic significance in relation to survival disparity between African-American and white breast cancer patients. If our findings are replicated in contemporary cohorts, it may be necessary to include hypertension in the Charlson Comorbidity Index and other comorbidity measures. © 2008 Wiley-Liss, Inc.

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