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J Community Health. 2015 Dec;40(6):1287-99. doi: 10.1007/s10900-015-0052-y.

Intersection of Race/Ethnicity and Socioeconomic Status in Mortality After Breast Cancer.

Author information

1
Cancer Prevention Institute of California, 2201 Walnut Ave, Suite 300, Fremont, CA, 94538, USA. salma.shariff-marco@cpic.org.
2
Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, CA, USA. salma.shariff-marco@cpic.org.
3
Stanford Cancer Institute, Stanford, CA, USA. salma.shariff-marco@cpic.org.
4
Cancer Prevention Institute of California, 2201 Walnut Ave, Suite 300, Fremont, CA, 94538, USA.
5
Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, CA, USA.
6
Stanford Cancer Institute, Stanford, CA, USA.
7
Department of Medicine (Oncology), Stanford University School of Medicine, Stanford, CA, USA.
8
Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
9
Division of Cancer Etiology, Department of Population Sciences, Beckman Research Institute of the City of Hope and City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
10
Division of Cancer Etiology, Beckman Research Institute of the City of Hope, Duarte, CA, USA.
11
Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
12
Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA.
13
Cancer Control Research Program, USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA.

Abstract

We investigated social disparities in breast cancer (BC) mortality, leveraging data from the California Breast Cancer Survivorship Consortium. The associations of race/ethnicity, education, and neighborhood SES (nSES) with all-cause and BC-specific mortality were assessed among 9372 women with BC (diagnosed 1993-2007 in California with follow-up through 2010) from four racial/ethnic groups [African American, Asian American, Latina, and non-Latina (NL) White] using Cox proportional hazards models. Compared to NL White women with high-education/high-nSES, higher all-cause mortality was observed among NL White women with high-education/low-nSES [hazard ratio (HR) (95 % confidence interval) 1.24 (1.08-1.43)], and African American women with low-nSES, regardless of education [high education HR 1.24 (1.03-1.49); low-education HR 1.19 (0.99-1.44)]. Latina women with low-education/high-nSES had lower all-cause mortality [HR 0.70 (0.54-0.90)] and non-significant lower mortality was observed for Asian American women, regardless of their education and nSES. Similar patterns were seen for BC-specific mortality. Individual- and neighborhood-level measures of SES interact with race/ethnicity to impact mortality after BC diagnosis. Considering the joint impacts of these social factors may offer insights to understanding inequalities by multiple social determinants of health.

KEYWORDS:

Breast cancer survival; Education; Neighborhood socioeconomic status; Racial/ethnic disparities; Socioeconomic disparities

PMID:
26072260
PMCID:
PMC4628564
DOI:
10.1007/s10900-015-0052-y
[Indexed for MEDLINE]
Free PMC Article

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