Historical Redlining, Treatment Storage and Disposal Facilities, and Breast Cancer Mortality 公开

Abstract

Previous Epidemiologic studies have explored the association between exposure to hazardous waste and breast cancer incidence. In this study, we aim to identify if there is an existing relationship with use of treatment, storage, and disposal facilities (TSDF’s) as a proxy for hazardous waste exposure, and a relationship with breast cancer mortality outcomes. Spatial analysis was used to determine if TSDF’s are more likely to be concentrated in Historically Redlined areas in Metro Atlanta. Using the Kernel Density Estimation (KDE) analysis and Global Moran’s I for Poisson distributed data, we determined that individuals living in HOLC Grade D, (most hazardous areas) are more likely to have a higher spatial concentration of TSDF’s in their census block group (CBG) compared to those living in HOLC Grade A (least hazardous areas). Among our analytic cohort we looked at 5,832 women diagnosed with breast cancer from the Georgia Cancer Registry. (Figure 5) A stratified Cox procedure estimated multivariable adjusted Hazard Ratios (HR) of breast cancer subtypes in relation to prevalence of TSDF’s and breast cancer mortality. In examining the associations between TSDF prevalence by exposure level and breast cancer mortality we observed large effect sizes, insignificant p-values, and wide CI's that included the null. Though precision was low, the largest effect size was observed among those living in a CBG with a high TSDF prevalence. Among the high TSDF exposure level, Luminal B (HR=1.23, 95% CI, 0.47-3.21, p=0.67) and TNBC (HR=1.11, 95% CI, 0.65-1.91, p=0.69) were associated with a small increased level of risk, with a high level of risk for BC mortality for those diagnosed with the HER2 subtype (HR=2.06, 95% CI, 0.68-6.16, p=0.20). (Table 4) Despite having over 5,000 women in our study larger studies are needed to understand the spatial distribution of TSDF’s and breast cancer mortality and investigate the biologic pathway that may contribute to the association.

Table of Contents

Introduction…………………………………………………………………………………..1

Thesis Aims…………………………………………………………………………………..4

Methods………………………………………………………………………………………4

Results………………………………………………………………………………………..8

Discussion…………………………………………………………………………………....11

Tables………………………………………………………………………………………...13

Figures………………………………………………………………………………………..18

References……………………………………………………………………………………23

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Environmental Health Sociology, Environmental Justice Health Sciences, Public Health
关键词	Health disparities Historical redlining Breast cancer mortality
Committee Chair / Thesis Advisor	Lauren E. McCullough, Emory University

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