PurposeTo evaluate the association of subjective social status (SSS) with metabolic syndrome (MetS) severity and its potential contribution to racial health disparities in women with breast cancer. Methods Multi-center cross-sectional study (10 US hospitals) in women (n=1206) with primary diagnosis of invasive breast cancer received during Mar/2013-Feb/2020. Participants, self-identi ed as non-Hispanic white or black, underwent physical and laboratory examinations and survey questions assessing socioeconomic parameters, medical history and behavioral risks. SSS was measured with the 10-rung McArthur scale. MetS severity was measured with a validated Z-Score. Generalized linear mixed modeling was used to analyze the associations. Missing data were handled using multiple imputation.ResultsAverage age was 58 years. On average, the SSS of black women, given equivalent level of income and education, was lower than the SSS of white women: 6.6 (6.1 to 7.0) vs 7.7 (7.54 to 7.79) among college graduates and 6.8 (6.4 to 7.2) vs 7.6 (7.5 to 7.8) among women in the high-income category (> $75,000). In multivariable analysis, after controlling for age, income, education, diet and physical activity, increasing SSS was associated with a decrease in MetS-Z, -0.10 (-0.16 to -0.04) per every 2 rung increase in the McArthur scale.Conclusion Black women with breast cancer rank their SSS lower than white women with breast cancer do at each level of income and education. As SSS is strongly associated with MetS severity these results identify potentially modi able factors that contribute to racial disparities.
PurposeTo evaluate the association of subjective social status (SSS) with metabolic syndrome (MetS) severity and its potential contribution to racial health disparities in women with breast cancer. Methods Multi-center cross-sectional study (10 US hospitals) in women (n=1206) with primary diagnosis of invasive breast cancer received during Mar/2013- Feb/2020. Participants, self-identified as non-Hispanic white or black, underwent physical and laboratory examinations and survey questions assessing socioeconomic parameters, medical history and behavioral risks. SSS was measured with the 10-rung McArthur scale. MetS severity was measured with a validated Z-Score. Generalized linear mixed modeling was used to analyze the associations. Missing data were handled using multiple imputation. ResultsAverage age was 58 years. On average, the SSS of black women, given equivalent level of income and education, was lower than the SSS of white women: 6.6 (6.1 to 7.0) vs 7.7 (7.54 to 7.79) among college graduates and 6.8 (6.4 to 7.2) vs 7.6 (7.5 to 7.8) among women in the high-income category (> $75,000). In multivariable analysis, after controlling for age, income, education, diet and physical activity, increasing SSS was associated with a decrease in MetS-Z, - 0.10 (-0.16 to -0.04) per every 2 rung increase in the McArthur scale. Conclusion Black women with breast cancer rank their SSS lower than white women with breast cancer do at each level of income and education. As SSS is strongly associated with MetS severity these results identify potentially modifiable factors that contribute to racial disparities.
The survival for breast cancer (BC) is improving, but remains lower in Black women than White women. A number of factors potentially drive the racial differences in BC outcomes. The aim of our study was to determine if insulin resistance, defined as homeostatic model assessment for insulin resistance (HOMA-IR) mediated part of the relationship between race and BC prognosis, defined as improved Nottingham prognostic index (iNPI). We performed a cross-sectional study, recruiting self-identified Black and White women with newly diagnosed primary invasive BC from ten US hospitals between March 2013 and February 2020. Surveys, anthropometrics, labs and tumor pathology data were gathered, and we compared the results between Black and White women. We calculated HOMA-IR as well as iNPI scores, and examined the associations between HOMA-IR and iNPI. After exclusions, the final cohort was 1206; 911 (76%) White, and 295 (24%) Black women. Metabolic syndrome, and insulin resistance were more common in Black than White women (P<0.001 for all comparisons). Black women had less lobular BC, three times more triple-negative BC, and BCs with higher stage and iNPI scores than White women. Fewer Black women had BC genetic testing performed. HOMA-IR mediated part of the association between race and iNPI, particularly in BCs that carried a good prognosis and were HR-positive. Higher HOMA-IR scores were associated with progesterone receptor (PR)-negative BC in White women, but not Black women. Overall, our results suggest that HOMA-IR contributes to the racial disparities in BC outcomes, particularly for women with HR-positive BC.
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