Lower Household Net Worth and Black Race Associated With Nonadherence to Hormonal Therapy for Early-Stage Breast Cancer


Key Points

  • Black race and lower household net worth were associated with greater risk of nonadherence to hormonal therapy for early-stage breast cancer.
  • The risk for nonadherence among black women was partly explained by the effect of lower household net worth.

In a study reported in the Journal of Clinical Oncology, Hershman et al found that nonadherence to adjuvant hormonal therapy for early-stage breast cancer was more common among black women and patients with lower household net worth, with the latter factor partly accounting for the racial disparity.

Study Details

In the study, the OptumInsight insurance claims database was used to identify women aged > 50 years diagnosed with early-stage breast cancer between January 2007 and December 2011 who were using hormonal therapy. Nonadherence was defined as a medication possession ratio of ≤ 80% of eligible days over a 2-year period.

Black Race and Lower Household Net Worth

Of 10,302 patients identified, 2,473 (24%) were nonadherent. In an unadjusted analysis, adherence was significantly less likely among black vs white women (odds ratio [OR] = 0.76, 95% confidence interval [CI] = 0.55–0.88) and borderline less likely among Hispanic vs white women (OR = 0.74, 95% CI = 0.55–1.00). Adherence was significantly associated with medium household net worth ($250,000–$750,000; OR = 1.33, P < .001) and high net worth (> $750,000; OR = 1.66, P < .001) vs low net worth (< $250,000).

When household net worth was added to the analysis, the negative association of black race with adherence was reduced (OR = 0.84, P < .05). In a multivariate analysis including race/ethnicity, region, net worth, household income, adjusted 30-day copay, Medicare, education, age at hormone therapy initiation, and number of comorbidities (all significantly associated with adherence on univariate analysis), black women were nonsignificantly less likely to be adherent (OR = 0.87, 95% CI = 0.74–1.01).


Interaction between race and net worth was significant, with no significant association of race observed in the medium and high net worth groups and a significant association observed in the low net worth group (P < .01). A stratified analysis by net worth showed that black women in the low net worth group had reduced adherence (OR = 0.81, P = .046), with no association observed between black race and adherence in the higher net worth groups.

The investigators concluded: “We found that net worth partially explains racial disparities in hormonal therapy adherence. These results suggest that economic factors may contribute to disparities in the quality of care.”

Dawn L. Hershman, MD, of Columbia University, is the corresponding author of the Journal of Clinical Oncology article.

The study was supported by the American Cancer Society, National Cancer Institute, and Breast Cancer Research Foundation.

Jason D. Wright, MD, reported research funding from Genentech. Alfred I. Neugut, MD, PhD, reported a consulting or advisory role with Executive Health Exams, Intl, and Pfizer.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.