Impact of Undetected Comorbidity on Treatment and Outcomes of Breast Cancer

Table 4

Survival.

	All-cause mortality				Cancer mortality				Other-cause mortality
	HR	95% CI		𝑃 value	HR	95% CI		𝑃 value	HR	95% CI		𝑃 value
		Lower	Upper			Lower	Upper			Lower	Upper
Age at cancer diagnosis (years)
66–70	Reference category
71–75	1.34	1.25	1.44	<0.0001	1.27	1.15	1.40	<0.0001	1.55	1.36	1.75	<0.0001
76–80	1.80	1.68	1.93	<0.0001	1.47	1.34	1.62	<0.0001	2.39	2.12	2.69	<0.0001
>80	3.41	3.20	3.63	<0.0001	2.08	1.90	2.28	<0.0001	5.74	5.15	6.41	<0.0001
Race/ethnicity
White	Reference category
Black	1.04	0.97	1.11	0.26	0.91	0.81	1.02	0.09	0.89	0.79	0.99	0.03
Hispanic	0.82	0.74	0.91	<0.01	0.96	0.83	1.12	0.62	0.89	0.76	1.03	0.12
Other	0.79	0.71	0.88	<0.0001	0.94	0.79	1.11	0.45	0.74	0.63	0.89	<0.01
Year of cancer diagnosis
2001	Reference category
2002	0.99	0.94	1.04	0.63	0.98	0.90	1.07	0.67	0.99	0.92	1.06	0.67
2003	0.97	0.92	1.02	0.26	1.00	0.91	1.09	0.91	0.88	0.82	0.96	<0.01
2004	0.91	0.86	0.97	<0.01	0.90	0.82	0.99	0.03	0.87	0.79	0.95	<0.01
2005	0.93	0.87	1.00	0.04	0.95	0.86	1.06	0.34	0.83	0.75	0.92	<0.01
Index of prior comorbidity score (NCI Comorbidity Index)
0	Reference category
1	1.45	1.39	1.52	<0.0001	1.18	1.10	1.27	<0.0001	1.79	1.68	1.91	<0.0001
≥2	2.05	1.95	2.16	<0.0001	1.34	1.22	1.47	<0.0001	2.86	2.66	3.07	<0.0001
Index of undetected comorbidity score
0	Reference category
1	1.45	1.38	1.53	<0.0001	1.32	1.21	1.43	<0.0001	1.58	1.46	1.71	<0.0001
≥2	2.38	2.18	2.60	<0.0001	1.67	1.43	1.95	<0.0001	3.31	2.94	3.73	<0.0001
Indicators of poor performance
0	Reference category
≥1	1.80	1.72	1.88	<0.0001	1.41	1.31	1.53	<0.0001	2.15	2.02	2.29	<0.0001
Stage at diagnosis
𝐼𝑛  𝑠𝑖𝑡𝑢	Reference category
I	1.79	1.66	1.94	<0.0001	2.66	2.21	3.20	<0.0001	1.44	1.31	1.60	<0.0001
II	2.95	2.73	3.19	<0.0001	7.88	6.59	9.41	<0.0001	1.81	1.63	2.01	<0.0001
III	6.03	5.52	6.58	<0.0001	22.08	18.37	26.54	<0.0001	2.52	2.21	2.86	<0.0001
IV	16.72	15.33	18.23	<0.0001	85.67	71.62	102.47	<0.0001	2.62	2.21	3.10	<0.0001
Histological grade
Well differentiated	Reference category
Moderately differentiated	1.11	1.05	1.18	<0.01	1.37	1.22	1.54	<0.0001	1.06	0.98	1.14	0.13
Poorly differentiated	1.47	1.39	1.56	<0.0001	2.28	2.02	2.56	<0.0001	1.14	1.05	1.24	<0.01
Undifferentiated/anaplastic	1.38	1.23	1.56	<0.0001	2.24	1.83	2.74	<0.0001	0.92	0.76	1.11	0.38
Missing/unknown	1.30	1.22	1.40	<0.0001	1.82	1.60	2.07	<0.0001	1.13	1.02	1.24	0.02
Estrogen (ER) and progesterone (PR) receptor status
ER and PR negative	Reference category
Either ER or PR positive	0.69	0.65	0.74	<0.0001	0.60	0.54	0.65	<0.0001	0.91	0.81	1.01	0.07
Both ER and PR positive	0.64	0.60	0.67	<0.0001	0.44	0.40	0.47	<0.0001	0.96	0.87	1.05	0.36
Unknown/missing	0.87	0.82	0.93	<0.0001	0.72	0.66	0.79	<0.0001	1.13	1.02	1.26	0.02
Percent in census tract with some college
<25%	Reference category
≥25%	1.03	0.99	1.07	0.15	1.05	0.99	1.12	0.09	1.08	1.02	1.15	0.01
Percent in census tract living in poverty
<5%	Reference category
5–7%	1.10	1.03	1.16	<0.01	1.11	1.01	1.21	0.03	1.08	0.99	1.17	0.08
8–12%	1.06	1.01	1.12	0.03	0.98	0.90	1.06	0.59	1.03	0.96	1.11	0.40
>12%	1.18	1.12	1.24	<0.0001	1.05	0.97	1.14	0.25	1.06	0.99	1.14	0.10
Type of geographic area
Large metropolitan	Reference category
Metropolitan	1.07	1.03	1.12	<0.01	0.99	0.92	1.06	0.70	0.99	0.93	1.05	0.71
Urban	0.97	0.89	1.05	0.38	0.81	0.70	0.93	<0.01	0.76	0.67	0.86	<0.0001
Less urban/rural	1.07	1.00	1.14	0.05	1.03	0.93	1.15	0.56	1.03	0.94	1.14	0.55

HR: Hazard Ratio; CI: Confidence Interval.