Racial and ethnic disparities in mental health among breast cancer patients and survivors in the United States

Ahmad Reshad Osmani; Asako Moriya; Shelley White-Means

doi:10.1111/1475-6773.14391

Racial and ethnic disparities in mental health among breast cancer patients and survivors in the United States

Health Serv Res. 2024 Oct 14. doi: 10.1111/1475-6773.14391. Online ahead of print.

Authors

Ahmad Reshad Osmani¹, Asako Moriya², Shelley White-Means^{3

4}

Affiliations

¹ Department of Economics and Finance, Louisiana State University (LSU) Shreveport, Shreveport, Louisiana, USA.
² Division of Research and Modeling, Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland, USA.
³ College of Graduate Health Sciences, Department of Interprofessional Education, The University of Tennessee Health Science Center, Memphis, Tennessee, USA.
⁴ Consortium for Health Education, Economic Empowerment and Research (CHEER), The University of Tennessee Health Science Center, Memphis, Tennessee, USA.

PMID: 39402858
DOI: 10.1111/1475-6773.14391

Abstract

Objective: To decompose the mental health disparities between breast cancer patients and survivors (hereafter survivors) of racial and ethnic minority groups and non-Hispanic White survivors into the contributions of individual-, interpersonal-, community-, and societal-level determinants.

Data sources and study setting: We used data from the 2010-2020 Medical Expenditure Panel Survey Household Component (MEPS-HC). Our primary outcome was whether the person had mental health conditions or not.

Study design: We employed the Kitagawa-Oaxaca-Blinder (KOB) method to understand to what extent the differences in outcomes were explained by the differences in the determinants between non-Hispanic Black or Hispanic breast cancer survivors and non-Hispanic White survivors. We also bifurcated the Hispanic sample analysis by the US-born status (and county of origin).

Data collection/extraction methods: Confidential geographic identifiers are utilized to supplement the MEPS-HC data with information on community characteristics and local healthcare resources.

Principal findings: The prevalence of mental health conditions among non-Hispanic Black and Hispanic breast cancer survivors was 26.1% (95% CI: 20.4, 31.7) and 28.3% (95% CI: 21.9, 34.6), respectively. These rates were higher than those for their non-Hispanic White counterparts, 19.7% (95% CI: 17.4, 21.9). In our KOB model, the disparity between non-Hispanic Black and White survivors was fully explained by differences in education, health, and family structure, with community- and societal-level determinants playing no significant role. Conversely, our KOB model did not explain any of the overall differences between Hispanic and non-Hispanic White survivors. However, for foreign-born Hispanic survivors, the disparity was fully explained by a combination of individual- and societal-level determinants.

Conclusions: Our findings, which identify specific individual-, interpersonal-, and societal- determinants that were associated with racial and ethnic differences in mental health, can be used by clinicians and policymakers to proactively address racial and ethnic disparities in health.

Keywords: chronic disease; determinants of health/population health/socioeconomic cause of health; health equity; racial/ethnic differences in health and healthcare.