Disparities in Breast Cancer Mortality: Examining the Influence of Area-Level Socioeconomic Conditions and the Role of Individual-Level Socioeconomic Factors in Shaping Estimates Öffentlichkeit
Brown, Nakai (Fall 2024)
Abstract
In the United States breast cancer is the second leading cause of death in women, and while White women are more likely to be diagnosed with breast cancer, Black women are more likely to die. There are many drivers of breast cancer outcomes, like neighborhood and socioeconomic condition, that impact access to and quality of care. In this study we aimed to examine whether area-level neighborhood socioeconomic condition is associated with race-specific breast cancer mortality to understand how meaningful individual-level socioeconomic data is in improving risk estimation. Using the I Can Care survey cohort and the BRIDGE breast cancer surveillance cohort, there were 1,944 non-Hispanic Black and non-Hispanic White women, who were diagnosed with breast cancer between 2012 to 2015. Our exposure was neighborhood deprivation, and the outcomes of interest were all-cause and breast cancer mortality. Cox proportional hazards regression was used to perform our analysis. We observed that as the level of neighborhood deprivation increased, the risk of all-cause and breast cancer mortality also increased. (Table 2) We also observed how neighborhood deprivation impacted Black and White women’s breast cancer mortality risk differently. (Table 3) Adjusting for individual socioeconomic status, we observed the most meaningful difference in risk when using education and household income. (Table 5) When stratified by race we observed drastic differences in the impact of the education and household income variables by race on breast cancer mortality. (Table 6) Our results suggest that living in neighborhoods that are more resource deprived, has a harmful impact on all-cause and breast cancer mortality and that racial disparities exist for the impact of neighborhood deprivation. Adjusting for individual level socioeconomic factors, like education level and household income, appear to be much more meaningful for White women than they are for Black women, suggesting the presence of other factors like systemic and institutional racism that create barriers that perpetuate health disparities. Due to small sample size, larger studies are needed to yield more statistically meaningful results and an expansion of the indicators used to create the neighborhood deprivation index variable may be beneficial to explore.
Table of Contents
Introduction and Background 1
Methods 4
Results 6
Discussion 16
Tables 23
References 28
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