Impact of Neighborhood and Individual Socioeconomic Status on Survival after Breast Cancer Varies by Race/Ethnicity: The Neighborhood and Breast Cancer Study

Abstract

Background Research is limited on the independent and joint effects of individual- and neighborhood-level socioeconomic status (SES) on breast cancer survival across different racial/ethnic groups. Methods We studied individual-level SES, measured by self-reported education, and a composite neighborhood SES (nSES) measure in females (1,068 non-Hispanic whites, 1,670 Hispanics, 993 African-Americans, and 674 Asian-Americans), aged 18–79 years and diagnosed 1995–2008, in the San Francisco Bay Area. We evaluated all-cause and breast cancer-specific survival using stage-stratified Cox proportional hazards models with cluster adjustment for census block groups. Results In models adjusting for education and nSES, lower nSES was associated with worse all-cause survival among African-Americans (p-trend=0.03), Hispanics (p-trend=0.01) and Asian-Americans (p-trend=0.01). Education was not associated with all-cause survival. For breast cancer-specific survival, lower nSES was associated with poorer survival only among Asian-Americans (p-trend=0.01). When nSES and education were jointly considered, women with low education and low nSES had 1.4 to 2.7-times worse all-cause survival than women with high education and high nSES across all races/ethnicities. Among African-Americans and Asian-Americans, women with high education and low nSES had 1.6 to 1.9-times worse survival, respectively. For breast cancer-specific survival, joint associations were found only among Asian-Americans with worse survival for those with low nSES regardless of education. Conclusions Both neighborhood and individual SES are associated with survival after breast cancer diagnosis, but these relationships vary by race/ethnicity. Impact A better understanding of the relative contributions and interactions of SES with other factors will inform targeted interventions towards reducing long-standing disparities in breast cancer survival.

Association of lifestyle and demographic factors with estrogenic and glucocorticogenic activity in Mexican American women

“…For the present analysis, we selected specific risk factors that we hypothesized could be associated with E or G activity at the time of blood draw, such as use of menopausal hormone therapy (HT), alcohol intake, body mass index (BMI) (40,41). Individual proportion of Indigenous American genetic ancestry was available for 86 of the 90 samples and was included in the analyses as a proxy for unmeasured sociocultural and/or biological differences.…”

The influence of neighborhood socioeconomic status and race on survival from ovarian cancer: a population-based analysis of Cook County, Illinois

“…One important contextual factor is neighborhood socioeconomic status (SES). Area-level measures of SES, including neighborhood SES, have been associated with a variety of health outcomes [24–28]. Significant associations have been observed between components of neighborhood SES and breast cancer screening [29], ovarian cancer tumor characteristics [15], and breast [30–33], ovarian [34], and prostate [35] cancer outcomes.…”

Race/ethnicity and socio-economic differences in breast cancer surgery outcomes

“…Disparities in breast cancer treatment and outcomes have been documented among Black and White women in the U.S over the past several decades [1][2][3][4][5][6]. Although Black women are less likely to develop breast cancer compared with Whites, once diagnosed, Black women are less likely to receive guideline-adherent treatment [7][8][9][10] and have significantly lower 5-year survival rates [11][12][13].…”

“…Variations in cancer treatment and treatment outcomes may partially account for the observed racial and socio-economic disparities in breast cancer mortality [2][3][4][5][6][7][8][9][10][11]. A growing number of studies indicate that African-American women are less likely to undergo breast-conserving surgery (BCS) compared with White women [2,[12][13][14] whereas other studies either reported no difference [15,16] or observed opposite findings [17,18].…”

“…A growing number of studies indicate that African-American women are less likely to undergo breast-conserving surgery (BCS) compared with White women [2,[12][13][14] whereas other studies either reported no difference [15,16] or observed opposite findings [17,18]. Many of these previous studies were conducted among Medicare recipients, [2,10,12,19,21] a population group aged 65 years and older, with limited data on socio-economic and health care access variables (beyond having Medicare insurance) in the Medicare dataset. Although overall survival rates are similar among women receiving BCS and mastectomy [25], it is not clear if there are significant differences in outcome by race/ethnicity and socioeconomic status (SES) among women receiving surgery.…”