Urban-rural disparities in the global south: The impact of urbanicity on obesity, comorbidities, and stage at diagnosis in breast cancer.

Abstract

e13628 Background: Obesity is a major risk factor for breast cancer (BC). With 87.9% of Egyptian women overweight or obese, clarifying the interplay between adiposity, urbanicity, and disease presentation is critical. We evaluated the impact of urbanicity on BMI, comorbidities, and cancer stage at diagnosis in a large Egyptian BC cohort. Methods: We retrospectively analyzed patients at the Baheya Foundation cancer registry. Patients were stratified into High, Moderate, and Low Urban groups based on CAPMAS governorate classifications. Demographics, BMI, comorbidities (DM, HTN, CVD), and clinical stage were compared using ANOVA and Chi-square tests. Results: Among 10,361 patients, 74.0% had obesity (BMI ≥30 kg/m²), exceeding national (49.5%) and international rates, including the UK (17.9%) and North India (33.6%). High Urban patients trended toward the highest mean BMI (34.47 kg/m²; P = 0.092) and had significantly higher comorbidities vs. Moderate and Low Urban groups: DM (30.7% vs. 29.1% vs. 24.8%; P = 0.002), HTN (43.3% vs. 42.5% vs. 36.3%; P < 0.001), and CVD (11.0% vs. 10.8% vs. 8.2%; P = 0.041). Paradoxically, High Urban patients presented significantly earlier (Stage I-II: 53.6%) than Low Urban patients (46.8%; P < 0.001). Conclusions: Egyptian BC patients bear a disproportionate burden of obesity compared to global and national averages. A striking paradox exists: High Urban patients present with a worse metabolic profile yet are diagnosed at earlier stages, likely due to superior access to screening and healthcare facilities. Conversely, Low Urban patients present with more advanced disease despite fewer metabolic comorbidities. These findings highlight the critical role of geographic healthcare disparities in disease prognosis. Future interventions must tailor risk assessment strategies to ethnicity and culture, integrating weight management for urban populations while prioritizing early detection access in less urbanized regions. Baseline patient characteristics by urbanicity. Variable Category High Urban Moderate Urban Low Urban Total p-value Age at diagnosis (years) Mean ± SD 54.11 ± 12.22 53.37 ± 12.23 51.63 ± 12.33 53.35 ± 12.27 <0.001 BMI category (kg/m²) <25 254 (6.5%) 380 (7.0%) 76 (7.2%) 710 (6.9%) 0.86 25–29.9 747 (19.1%) 1,036 (19.2%) 199 (18.8%) 1,982 (19.1%) ≥30 2,900 (74.3%) 3,985 (73.8%) 784 (74.0%) 7,669 (74.0%) Diabetes mellitus 1,039 (30.7%) 1,383 (29.1%) 238 (24.8%) 2,660 (29.2%) 0.002 Hypertension 1,485 (43.3%) 2,040 (42.5%) 350 (36.3%) 3,875 (42.2%) <0.001 Cardiovascular disease 361 (11.0%) 501 (10.8%) 76 (8.2%) 938 (10.6%) 0.04 Clinical stage Early (I-II) 1,891 (53.6%) 2,515 (51.8%) 448 (46.8%) 4,854 (52.0%) <0.001 Late (III-IV) 1,638 (46.4%) 2,337 (48.2%) 510 (53.2%) 4,485 (48.0%)