Racial disparities in breast cancer care among reproductive-aged women continued after COVID-19 pandemic.

person Usha Periyanayagam Komodo Health, San Francisco, CA info_outline Usha Periyanayagam, Ethan Yung, Christine Kim, Lyuba Popadic, Francesca Devine

Authors person Usha Periyanayagam Komodo Health, San Francisco, CA info_outline Usha Periyanayagam, Ethan Yung, Christine Kim, Lyuba Popadic, Francesca Devine Organizations Komodo Health, San Francisco, CA, Komodo Health, New York, NY Abstract Disclosures Research Funding No funding sources reported Background: Despite the aggressive nature of breast cancer (BC) among women under 45 years old, racial disparities in BC care still exist. The COVID-19 pandemic highlighted racial disparities in care management. This study described staging, treatment use, and healthcare resource use (BC-HCRU) among reproductive-aged White, Asian, and Black women before and after COVID-19 to identify possible care changes. Methods: This retrospective claims study assessed White, Asian, and Black women aged 18 to 44 years old with newly diagnosed BC in the Komodo Research Dataset from August 2018-May 2023. Women were stratified based on their first observable BC diagnosis (index) into two cohorts, pre-COVID-19 (pre) (February-July 2019) and post-COVID-19 (post) (July-November 2022). Patients were required to have >6 months of medical and pharmacy continuous enrollment before (baseline) and after index (follow-up), and a second BC diagnosis during follow-up. BC-HCRU was defined as a claim with a BC diagnosis. Results: Pre-COVID-19 included 875 White, 116 Asian, and 267 Black women (mean age 39.0 years, 38.5 years and 37.8 years respectively) and post-COVID-19 included 879 White, 127 Asian, 386 Black women (mean age 38.8 years, 38.9 years and 37.9 years respectively). While the proportions with commercial insurance decreased (pre: White, Asian, Black: 72.5%, 71.6%, 42.7%; post: 51.9%, 61.4%, 23.6%) and with Medicaid increased (pre: White, Asian, Black: 24.3%, 27.6%, 53.6%; post: 45.2%, 38.6%, 75.1%) for all, most White and Asian women had commercial insurance and most Black women had Medicaid pre- and post-COVID-19. The proportion with metastatic BC increased for all in the post period, but lower incidences remained among White (pre: 20.7%; post: 25.1%) and Asian (pre: 17.2%; post: 22.8%) than Black women (pre: 25.5%; post: 28.0%). While both the proportions of White and Asian women with BC-related ER visits increased, suggesting greater acute care needs, the proportion of Asian women doubled and became higher than White women; the highest incidence also remained among Black women (pre: White, Asian, Black: 13.1%, 7.8%, 22.8%; post: 15.4%, 18.1%, 21.0%). The proportion with any treatment (medication, surgery, radiation) remained highest for Asian women (pre: 87.9%; post: 90.6%) and decreasingly lowest for Black women (pre: 84.3%; post: 80.3%), and the mean time to treatment remained shortest for White women (pre: 40.3 days; post: 44.3) and longest for Black women (pre: 47.4; post: 49.8). Conclusions: While COVID-19 affected BC care among all reproductive-aged women, racial disparities in BC care remained or increased in this vulnerable population. Comparative analyses assessing the factors driving these disparities should be explored to understand these health inequities further, and real-world clinical practice should consider these differences when implementing necessary BC management.