A comparison of black and white women with breast cancer in the Deep South and their experiences utilizing theAoUdataset

Purpose: In 2024, Black women had a 38% higher breast cancer mortality rate than their white counterparts, despite a lower incidence. The impact of the social determinants of health (SDoH) within this disparity remains unclear. The Deep South, an area associated with poorer health outcomes, hosts the highest cancer-related death rates nationwide. As such, evaluation of women with breast cancer in this region may influence the understanding of socioeconomic burden. This research examines and compares perceptions of healthcare interactions, access to infrastructure, and community dynamics to contribute to the understanding of social determinants in a black, southern population living with breast cancer. Methods: Participant and survey data were derived from the All of Us Research Program (AoURP) workbench and SDOH survey. The AoURP is an initiative focused on improving health outcomes through a diverse research database. Inclusion criteria consisted of adult women with breast cancer who self-identified as White or Black/African American and lived in the Deep South (Alabama, Georgia, Louisiana, and Mississippi). Selected survey questions addressed neighborhood perspectives, access to neighborhood resources, and discriminatory experiences in healthcare settings. Black and white participants were identified via the cohort selection tool and further subdivided based on 3-digit zip code values. Using Python in Jupyter Notebook, participant responses were extracted and quantified to allow comparison. Results: Inclusion criteria were met by 457 black women and 587 white women. Response counts per survey question varied. Black women were significantly more likely to express that their neighborhoods were noisy, unsafe, and unclean. Additionally, black women felt less listened to during health care experiences (p= 0.0068) and as if they were treated with less courtesy (p = 0.0001). Most questions addressing infrastructure did not result in statistically significant differences. Low-cost recreational facilities and shops were not within walking distance for the majority of both black and white respondents. Conclusion: These results indicate that black women with breast cancer are impacted by aspects of the SDoH more than their white counterparts. Negative neighborhood dynamics, as well as feelings of less respect and courtesy, may impact prognosis and rates of early diagnosis. Additionally, both cohorts indicated a disparity in infrastructure, which aligns with the predominantly rural composition of the Deep South.