Socioeconomic inequities in care experienced by women with breast cancer in England: An intersectional cross-sectional study

Purpose Guided by the intersectionality framework, we examined the differential in breast cancer care experience across population subgroups in England. Methods Secondary data analysis using the 2017/2018 English National Cancer Patient Experience Survey (NCPES). We applied disaggregated descriptive statistics (mean, standard errors, 95% confidence interval) to analyse 26,030 responses from female breast cancer patients to a question relating to overall care experience categorised by age, ethnicity, and sexual orientation in their intersection with deprivation status. We then applied multivariable logistic regression (odds ratios, 95% confidence intervals) to ascertain the relationship of reporting a positive care experience adjusting for patient, clinical, and trust-level factors. Results Poorer breast cancer care experience was mostly reported by the most deprived younger and minoritised ethnic groups. Similar findings were observed in adjusted multivariable analyses. Younger respondents were less likely than older patients to rate their care favourably. Pakistani, Indian, Chinese, and Black African women were less likely than White British women to rate their care favourably. Respondents from the most socioeconomic deprived backgrounds were less likely than the most affluent ones to rate their care favourably. Conclusion There is evidence of inequity in overall cancer care experience among female breast cancer patients in England, particularly among women living at the specific intersection of age, ethnicity and socioeconomic position. Future research is necessary to understand the mechanisms underlying breast cancer inequities. Policymakers, commissioners, and providers should consider the existence of multiple forms of marginalization to inform improvement initiatives targeting patients at higher risk of vulnerability. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work has been supported by the University of Surrey Doctoral Studentship Award (TV8330). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Survey data available for non-for-profit research from the UK Data Service (UK Data Service). The datasets were anonymised at source, therefore ethical approval was not required to conduct secondary analysis of these national data. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript. Survey data available for non-for-profit research from the UK Data Service (UK Data Service)