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Cancer Epidemiol Biomarkers Prev. 2015 Aug;24(8):1282-90. doi: 10.1158/1055-9965.EPI-15-0055. Epub 2015 Jun 10.

Contribution of the neighborhood environment and obesity to breast cancer survival: the California Breast Cancer Survivorship Consortium.

Author information

1
Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California. iona.cheng@cpic.org.
2
Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California. Stanford University School of Medicine, Stanford, California.
3
Cancer Prevention Institute of California, Fremont, California.
4
University of Southern California, Keck School of Medicine, Los Angeles, California.
5
Stanford Cancer Institute, Stanford, California. Stanford University School of Medicine, Stanford, California.
6
Division of Research, Kaiser Permanente Northern California, Oakland, California.
7
City of Hope, Duarte, California.
8
University of Southern California, Children's Hospital, Los Angeles, California.

Abstract

Little is known about neighborhood attributes that may influence opportunities for healthy eating and physical activity in relation to breast cancer mortality. We used data from the California Breast Cancer Survivorship Consortium and the California Neighborhoods Data System (CNDS) to examine the neighborhood environment, body mass index, and mortality after breast cancer. We studied 8,995 African American, Asian American, Latina, and non-Latina white women with breast cancer. Residential addresses were linked to the CNDS to characterize neighborhoods. We used multinomial logistic regression to evaluate the associations between neighborhood factors and obesity and Cox proportional hazards regression to examine associations between neighborhood factors and mortality. For Latinas, obesity was associated with more neighborhood crowding [quartile 4 (Q4) vs. Q1: OR, 3.24; 95% confidence interval (CI), 1.50-7.00]; breast cancer-specific mortality was inversely associated with neighborhood businesses (Q4 vs. Q1: HR, 0.46; 95% CI, 0.25-0.85) and positively associated with multifamily housing (Q3 vs. Q1: HR, 1.98; 95% CI, 1.20-3.26). For non-Latina whites, lower neighborhood socioeconomic status (SES) was associated with obesity [quintile 1 (Q1) vs. Q5: OR, 2.52; 95% CI, 1.31-4.84], breast cancer-specific (Q1 vs. Q5: HR, 2.75; 95% CI, 1.47-5.12), and all-cause (Q1 vs. Q5: HR, 1.75; 95% CI, 1.17-2.62) mortality. For Asian Americans, no associations were seen. For African Americans, lower neighborhood SES was associated with lower mortality in a nonlinear fashion. Attributes of the neighborhood environment were associated with obesity and mortality following breast cancer diagnosis, but these associations differed across racial/ethnic groups.

PMID:
26063477
PMCID:
PMC4687960
DOI:
10.1158/1055-9965.EPI-15-0055
[Indexed for MEDLINE]
Free PMC Article

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