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Pittell H, Calip GS, Pierre A, Ryals CA, Guadamuz JS. Racialized economic segregation and inequities in treatment initiation and survival among patients with metastatic breast cancer. Breast Cancer Res Treat 2024:10.1007/s10549-024-07319-5. [PMID: 38702585 DOI: 10.1007/s10549-024-07319-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/28/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Racialized economic segregation, a form of structural racism, may drive persistent inequities among patients with breast cancer. We examined whether a composite area-level index of racialized economic segregation was associated with real-world treatment and survival in metastatic breast cancer (mBC). METHODS We conducted a retrospective cohort study among adult women with mBC using a US nationwide electronic health record-derived de-identified database (2011-2022). Population-weighted quintiles of the index of concentration at the extremes were estimated using census tract data. To identify inequities in time to treatment initiation (TTI) and overall survival (OS), we employed Kaplan-Meier methods and estimated hazard ratios (HR) adjusted for clinical factors. RESULTS The cohort included 27,459 patients. Compared with patients from the most privileged areas, those from the least privileged areas were disproportionately Black (36.9% vs. 2.6%) or Latinx (13.2% vs. 2.6%) and increasingly diagnosed with de novo mBC (33.6% vs. 28.9%). Those from the least privileged areas had longer median TTI than those from the most privileged areas (38 vs 31 days) and shorter median OS (29.7 vs 39.2 months). Multivariable-adjusted HR indicated less timely treatment initiation (HR 0.87, 95% CI 0.83, 0.91, p < 0.01) and worse OS (HR 1.19, 95% CI 1.13, 1.25, p < 0.01) among those from the least privileged areas compared to the most privileged areas. CONCLUSION Racialized economic segregation is a social determinant of health associated with treatment and survival inequities in mBC. Public investments directly addressing racialized economic segregation and other forms of structural racism are needed to reduce inequities in cancer care and outcomes.
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Affiliation(s)
- Harlan Pittell
- Flatiron Health, 233 Spring St, New York, NY, 10013, USA.
| | - Gregory S Calip
- Program on Medicines and Public Health, University of Southern California School of Pharmacy, Los Angeles, USA
| | - Amy Pierre
- Flatiron Health, 233 Spring St, New York, NY, 10013, USA
- Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cleo A Ryals
- Flatiron Health, 233 Spring St, New York, NY, 10013, USA
| | - Jenny S Guadamuz
- Flatiron Health, 233 Spring St, New York, NY, 10013, USA
- Division of Health Policy and Management, Berkeley School of Public Health, University of California, Berkeley, USA
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Abdel Magid HS, Jaros S, Li Y, Steinman MA, Lee S, Peralta C, Jing B, Fung K, Liu CK, Liu X, Graham LA, Odden MC. Effects of residential socioeconomic polarization on high blood pressure among nursing home residents. Health Place 2024; 87:103243. [PMID: 38663339 DOI: 10.1016/j.healthplace.2024.103243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE Neighborhood concentration of racial, income, education, and housing deprivation is known to be associated with higher rates of hypertension. The objective of this study is to examine the association between tract-level spatial social polarization and hypertension in a cohort with relatively equal access to health care, a Veterans Affairs nursing home. METHODS 41,973 long-term care residents aged ≥65 years were matched with tract-level Indices of Concentration at the Extremes across four socioeconomic domains. We modeled high blood pressure against these indices controlling for individual-level cardiovascular confounders. RESULTS We found participants who had resided in the most disadvantaged quintile had a 1.10 (95% 1.01, 1.19) relative risk of high blood pressure compared to those in the other quintiles for the joint measuring race/ethnicity and income domain. CONCLUSIONS We achieved our objective by demonstrating that concentrated deprivation is associated with worse cardiovascular outcomes even in a population with equal access to care. Measures that jointly consider economic and racial/ethnic polarization elucidate larger disparities than single domain measures.
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Affiliation(s)
- Hoda S Abdel Magid
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, CA, USA; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Samuel Jaros
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, CA, USA
| | - Yongmei Li
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, CA, USA
| | - Michael A Steinman
- Division of Geriatrics, University of California San Francisco and the San Francisco VA Medical Center, SF, California, USA
| | - Sei Lee
- Division of Geriatrics, University of California San Francisco and the San Francisco VA Medical Center, SF, California, USA
| | - Carmen Peralta
- Division of Geriatrics, University of California San Francisco and the San Francisco VA Medical Center, SF, California, USA
| | - Bocheng Jing
- Division of Geriatrics, University of California San Francisco and the San Francisco VA Medical Center, SF, California, USA
| | - Kathy Fung
- Division of Geriatrics, University of California San Francisco and the San Francisco VA Medical Center, SF, California, USA; Geriatrics, Palliative, and Extended Care Service Line, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Christine K Liu
- Section of Geriatric Medicine, Division of Primary Care and Population Health, School of Medicine, Stanford University, Stanford, CA, USA; Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Xiaojuan Liu
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, CA, USA; Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Laura A Graham
- Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, CA, USA; Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University, Stanford, CA, USA
| | - Michelle C Odden
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, CA, USA; Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
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Guimarães JMN, Pescarini JM, de Sousa Filho JF, Ferreira A, de Almeida MDCC, Gabrielli L, dos-Santos-Silva I, Santos G, Barreto ML, Aquino EML. Income Segregation, Conditional Cash Transfers, and Breast Cancer Mortality Among Women in Brazil. JAMA Netw Open 2024; 7:e2353100. [PMID: 38270952 PMCID: PMC10811554 DOI: 10.1001/jamanetworkopen.2023.53100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/04/2023] [Indexed: 01/26/2024] Open
Abstract
Importance Women living in income-segregated areas are less likely to receive adequate breast cancer care and access community resources, which may heighten breast cancer mortality risk. Objective To investigate the association between income segregation and breast cancer mortality and whether this association is attenuated by receipt of the Bolsa Família program (BFP), the world's largest conditional cash-transfer program. Design, Setting, and Participants This cohort study was conducted using data from the 100 Million Brazilian Cohort, which were linked with nationwide mortality registries (2004-2015). Data were analyzed from December 2021 to June 2023. Study participants were women aged 18 to 100 years. Exposure Women's income segregation (high, medium, or low) at the municipality level was obtained using income data from the 2010 Brazilian census and assessed using dissimilarity index values in tertiles (low [0.01-0.25], medium [0.26-0.32], and high [0.33-0.73]). Main Outcomes and Measures The main outcome was breast cancer mortality. Mortality rate ratios (MRRs) for the association of segregation with breast cancer deaths were estimated using Poisson regression adjusted for age, race, education, municipality area size, population density, area of residence (rural or urban), and year of enrollment. Multiplicative interactions of segregation and BFP receipt (yes or no) in the association with mortality (2004-2015) were assessed. Results Data on 21 680 930 women (mean [SD] age, 36.1 [15.3] years) were analyzed. Breast cancer mortality was greater among women living in municipalities with high (adjusted MRR [aMRR], 1.18; 95% CI, 1.13-1.24) and medium (aMRR, 1.08; 95% CI, 1.03-1.12) compared with low segregation. Women who did not receive BFP had higher breast cancer mortality than BFP recipients (aMRR, 1.17; 95% CI, 1.12-1.22). By BFP strata, women who did not receive BFP and lived in municipalities with high income segregation had a 24% greater risk of death from breast cancer compared with those living in municipalities with low income segregation (aMRR, 1.24: 95% CI, 1.14-1.34); women who received BFP and were living in areas with high income segregation had a 13% higher risk of death from breast cancer compared with those living in municipalities with low income segregation (aMRR, 1.13; 95% CI, 1.07-1.19; P for interaction = .008). Stratified by the amount of time receiving the benefit, segregation (high vs low) was associated with an increase in mortality risk for women receiving BFP for less time but not for those receiving it for more time (<4 years: aMRR, 1.16; 95% CI, 1.07-1.27; 4-11 years: aMRR, 1.09; 95% CI, 1.00-1.17; P for interaction <.001). Conclusions and Relevance These findings suggest that place-based inequities in breast cancer mortality associated with income segregation may be mitigated with BFP receipt, possibly via improved income and access to preventive cancer care services among women, which may be associated with early detection and treatment and ultimately reduced mortality.
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Affiliation(s)
| | - Julia M. Pescarini
- Center for Data and Knowledge Integration for Health, Fiocruz, Salvador, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Andrea Ferreira
- Center for Data and Knowledge Integration for Health, Fiocruz, Salvador, Brazil
- Ubuntu Center on Racism, Global Movements and Population Health Equity, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | | | - Ligia Gabrielli
- Secretaria de Saúde do Estado da Bahia, Centro de Diabetes e Endocrinologia da Bahia, Salvador, Brazil
| | - Isabel dos-Santos-Silva
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gervasio Santos
- Center for Data and Knowledge Integration for Health, Fiocruz, Salvador, Brazil
| | - Mauricio L. Barreto
- Center for Data and Knowledge Integration for Health, Fiocruz, Salvador, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Estela M. L. Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
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Jayasekera J, El Kefi S, Fernandez JR, Wojcik KM, Woo JMP, Ezeani A, Ish JL, Bhattacharya M, Ogunsina K, Chang CJ, Cohen CM, Ponce S, Kamil D, Zhang J, Le R, Ramanathan AL, Butera G, Chapman C, Grant SJ, Lewis-Thames MW, Dash C, Bethea TN, Forde AT. Opportunities, challenges, and future directions for simulation modeling the effects of structural racism on cancer mortality in the United States: a scoping review. J Natl Cancer Inst Monogr 2023; 2023:231-245. [PMID: 37947336 PMCID: PMC10637025 DOI: 10.1093/jncimonographs/lgad020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/23/2023] [Accepted: 07/03/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE Structural racism could contribute to racial and ethnic disparities in cancer mortality via its broad effects on housing, economic opportunities, and health care. However, there has been limited focus on incorporating structural racism into simulation models designed to identify practice and policy strategies to support health equity. We reviewed studies evaluating structural racism and cancer mortality disparities to highlight opportunities, challenges, and future directions to capture this broad concept in simulation modeling research. METHODS We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review Extension guidelines. Articles published between 2018 and 2023 were searched including terms related to race, ethnicity, cancer-specific and all-cause mortality, and structural racism. We included studies evaluating the effects of structural racism on racial and ethnic disparities in cancer mortality in the United States. RESULTS A total of 8345 articles were identified, and 183 articles were included. Studies used different measures, data sources, and methods. For example, in 20 studies, racial residential segregation, one component of structural racism, was measured by indices of dissimilarity, concentration at the extremes, redlining, or isolation. Data sources included cancer registries, claims, or institutional data linked to area-level metrics from the US census or historical mortgage data. Segregation was associated with worse survival. Nine studies were location specific, and the segregation measures were developed for Black, Hispanic, and White residents. CONCLUSIONS A range of measures and data sources are available to capture the effects of structural racism. We provide a set of recommendations for best practices for modelers to consider when incorporating the effects of structural racism into simulation models.
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Affiliation(s)
- Jinani Jayasekera
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Safa El Kefi
- NYU Langone Health, New York University, New York, NY, USA
| | - Jessica R Fernandez
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Kaitlyn M Wojcik
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer M P Woo
- Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health, Bethesda, MD, USA
| | - Adaora Ezeani
- Health Behaviors Research Branch of the Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Jennifer L Ish
- Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health, Bethesda, MD, USA
| | - Manami Bhattacharya
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, and the Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Kemi Ogunsina
- Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health, Bethesda, MD, USA
| | - Che-Jung Chang
- Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health, Bethesda, MD, USA
| | - Camryn M Cohen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Stephanie Ponce
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Dalya Kamil
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Julia Zhang
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
- Sophomore at Williams College, Williamstown, MA, USA
| | - Randy Le
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Amrita L Ramanathan
- Diabetes, Endocrinology, & Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Gisela Butera
- Office of Research Services, National Institutes of Health Library, Bethesda, MD, USA
| | - Christina Chapman
- Department of Radiation Oncology, Baylor College of Medicine, and the Center for Innovations in Quality, Effectiveness, and Safety in the Department of Medicine, Baylor College of Medicine and the Houston Veterans Affairs, Houston, TX, USA
| | - Shakira J Grant
- Department of Medicine, Division of Hematology, University of North Carolina, Chapel Hill, NC, USA
| | - Marquita W Lewis-Thames
- Department of Medical Social Science, Center for Community Health at Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chiranjeev Dash
- Office of Minority Health and Health Disparities Research at the Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Traci N Bethea
- Office of Minority Health and Health Disparities Research at the Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Allana T Forde
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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5
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Igissin N, Toguzbayeva A, Khamidullina Z, Telmanova Z, Bilyalova Z, Kudaibergenova I, Muratbekova S, Igissinova G, Rustemova K, Kulmirzayeva D, Syzdykov N, Taszhanov R, Turebayev D, Orazova G, Kassenova D, Detochkina V, Baibosynov D, Kuandykov Y. Epidemiology of Breast Cancer Mortality in Kazakhstan, trends and Geographic Distribution. Asian Pac J Cancer Prev 2023; 24:3361-3371. [PMID: 37898839 PMCID: PMC10770671 DOI: 10.31557/apjcp.2023.24.10.3361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/10/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND According to the International Agency for Research on Cancer, ongoing demographic changes will lead to an increase in the number of deaths from breast cancer (BC) per year in the vast majority of regions. In 2040 it is expected that 1.04 million people worldwide will die from this malignancy, including 2,380 women in Kazakhstan. METHODS The retrospective study (2009-2018) was done using descriptive and analytical methods of oncoepidemiology. The extensive, crude and age-specific incidence rates are determined according to the generally accepted methodology used in sanitary statistics. The data were used to calculate the average percentage change (APС) using the Joinpoint regression analysis to determine the trend over the study period. RESULTS During 10 years 12,958 women died from BC. An average age of the death was 61.6 years (95%CI=60.6-62.6) and tended to increase (APC=+0.6%, R2=0.6117). Age-specific rates had a bimodal increase with peak rates at 70-74 years - 76.7±5.5 (APC=+3.4%, R2=0.2656) and 80-84 years - 78.0±9.1 (APC=+3.7%, R2=0.0875). The age-standardized rate was 13.9 per 100,000 of female population, and the trend has decreased. When compiling thematic maps, mortality rates were determined on the basis of standardized indicators: low - up to 12.5, average - from 12.5 to 15.2, high - above 15.2 per 100,000. The results of the spatial analysis showed the regions with a higher levels of BC mortality rate per 100,000: Pavlodar (16.9), Almaty (19.2) and Astana cities (19.3). CONCLUSIONS Age-standardized mortality rates had a strong downward trend (APC=-4.0%, R2=0.9218). The decrease mostly is due to a large coverage of the population by mammography screening and to an improvement in the effectiveness of breast cancer treatment.
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Affiliation(s)
- Nurbek Igissin
- Research Institute of Life and Health Sciences, Higher School of Medicine, Kokshetau University named after Sh. Ualikhanov, Kokshetau, Kazakhstan.
- Central Asian Institute for Medical Research, Astana, Kazakhstan.
- Asian Pacific Organization for Cancer Prevention, Bishkek, Kyrgyzstan.
| | - Assem Toguzbayeva
- Central Asian Institute for Medical Research, Astana, Kazakhstan.
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan.
| | | | - Zhansaya Telmanova
- Central Asian Institute for Medical Research, Astana, Kazakhstan.
- Asian Pacific Organization for Cancer Prevention, Bishkek, Kyrgyzstan.
| | - Zarina Bilyalova
- Central Asian Institute for Medical Research, Astana, Kazakhstan.
- Asian Pacific Organization for Cancer Prevention, Bishkek, Kyrgyzstan.
| | - Indira Kudaibergenova
- Asian Pacific Organization for Cancer Prevention, Bishkek, Kyrgyzstan.
- Akhunbaev Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan.
| | - Svetlana Muratbekova
- Research Institute of Life and Health Sciences, Higher School of Medicine, Kokshetau University named after Sh. Ualikhanov, Kokshetau, Kazakhstan.
| | - Gulnur Igissinova
- Central Asian Institute for Medical Research, Astana, Kazakhstan.
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan.
| | - Kulsara Rustemova
- Central Asian Institute for Medical Research, Astana, Kazakhstan.
- Astana Medical University, Astana, Kazakhstan.
| | | | - Nariman Syzdykov
- Central Asian Institute for Medical Research, Astana, Kazakhstan.
- Health Department of the Akmola region, Kokshetau, Kazakhstan.
| | - Rustem Taszhanov
- Central Asian Institute for Medical Research, Astana, Kazakhstan.
- Kokshetau Higher Medical College, Kokshetau, Kazakhstan.
| | - Dulat Turebayev
- Central Asian Institute for Medical Research, Astana, Kazakhstan.
- Astana Medical University, Astana, Kazakhstan.
| | | | - Dinara Kassenova
- Central Asian Institute for Medical Research, Astana, Kazakhstan.
- Astana Medical University, Astana, Kazakhstan.
| | | | - Daulet Baibosynov
- Central Asian Institute for Medical Research, Astana, Kazakhstan.
- Astana Medical University, Astana, Kazakhstan.
| | - Yerlan Kuandykov
- Khoja Akhmet Yassawi International Kazakh-Turkish University, Shymkent, Kazakhstan.
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Siegel SD, Brooks MM, Berman JD, Lynch SM, Sims-Mourtada J, Schug ZT, Curriero FC. Neighborhood factors and triple negative breast cancer: The role of cumulative exposure to area-level risk factors. Cancer Med 2023. [PMID: 36916687 DOI: 10.1002/cam4.5808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 01/08/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Despite similar incidence rates among Black and White women, breast cancer mortality rates are 40% higher among Black women. More than half of the racial difference in breast cancer mortality can be attributed to triple negative breast cancer (TNBC), an aggressive subtype of invasive breast cancer that disproportionately affects Black women. Recent research has implicated neighborhood conditions in the etiology of TNBC. This study investigated the relationship between cumulative neighborhood-level exposures and TNBC risk. METHODS This single-institution retrospective study was conducted on a cohort of 3316 breast cancer cases from New Castle County, Delaware (from 2012 to 2020), an area of the country with elevated TNBC rates. Cases were stratified into TNBC and "Non-TNBC" diagnosis and geocoded by residential address. Neighborhood exposures included census tract-level measures of unhealthy alcohol use, metabolic dysfunction, breastfeeding, and environmental hazards. An overall cumulative risk score was calculated based on tract-level exposures. RESULTS Univariate analyses showed each tract-level exposure was associated with greater TNBC odds. In multivariate analyses that controlled for patient-level race and age, tract-level exposures were not associated with TNBC odds. However, in a second multivariate model that included patient-level variables and considered tract-level risk factors as a cumulative exposure risk score, each one unit increase in cumulative exposure was significantly associated with a 10% increase in TNBC odds. Higher cumulative exposure risk scores were found in census tracts with relatively high proportions of Black residents. CONCLUSIONS Cumulative exposure to neighborhood-level risk factors that disproportionately affect Black communities was associated with greater TNBC risk.
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Affiliation(s)
- Scott D Siegel
- Institute for Research on Equity & Community Health, Christiana Care Health System, Newark, Delaware, USA.,Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, Delaware, USA
| | - Madeline M Brooks
- Institute for Research on Equity & Community Health, Christiana Care Health System, Newark, Delaware, USA
| | - Jesse D Berman
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Shannon M Lynch
- Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Jennifer Sims-Mourtada
- Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, Delaware, USA
| | - Zachary T Schug
- The Wistar Institute Cancer Center, Philadelphia, Pennsylvania, USA
| | - Frank C Curriero
- Department of Epidemiology, Johns Hopkins School of Public Health, John Hopkins Spatial Science for Public Health Center, Baltimore, Maryland, USA
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7
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Deng Z, Jones MR, Wang MC, Wolff AC, Visvanathan K. Racial and ethnic disparities in mortality among breast cancer survivors after a second malignancy. J Natl Cancer Inst 2023; 115:279-287. [PMID: 36529890 PMCID: PMC9996210 DOI: 10.1093/jnci/djac220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/29/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Racial and ethnic differences in survival after a first cancer are well established but have not been examined after a second primary cancer (SPC) despite the increasing incidence among survivors. METHODS We examined 39 029 female breast cancer survivors who developed an SPC between 2000 and 2014 in the Surveillance, Epidemiology, and End Results 18 database. Multivariable Cox proportional hazards regression for competing risks data was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for cancer and cardiovascular disease mortality after SPCs comparing Hispanic, Non-Hispanic Asian, and Non-Hispanic Black survivors with Non-Hispanic White survivors. Models were adjusted for sociodemographics, tumor characteristics, and treatments of the first and second cancer. Analyses were stratified by SPC type. RESULTS During 17 years of follow-up, there were 15 117 deaths after SPCs. The risk of cancer death was 12% higher among Non-Hispanic Black survivors (HR = 1.12, 95% CI = 1.05 to 1.19) and 8% higher among Hispanic survivors (HR = 1.08, 95% CI = 1.00 to 1.16) compared with Non-Hispanic White survivors. In subgroup analyses, the strongest associations were observed among Non-Hispanic Black survivors with a second breast or uterine cancer and among Hispanic survivors with a second breast cancer. Non-Hispanic Black survivors also experienced a 44% higher risk of cardiovascular disease death after SPC diagnosis than Non-Hispanic White survivors (HR = 1.44, 95% CI = 1.20 to 1.74). CONCLUSIONS Higher cancer mortality among Non-Hispanic Black and Hispanic survivors and higher cardiovascular mortality among Non-Hispanic Black survivors exist among women who survive a first breast cancer to develop an SPC. Studies focused on identifying the contributors to these disparities are needed to enable implementation of effective mitigation strategies.
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Affiliation(s)
- Zhengyi Deng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Miranda R Jones
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Oncology, Kimmel Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Mei-Cheng Wang
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Antonio C Wolff
- Department of Oncology, Kimmel Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Oncology, Kimmel Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
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8
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Fuemmeler BF, Shen J, Zhao H, Winn R. Neighborhood deprivation, racial segregation and associations with cancer risk and outcomes across the cancer-control continuum. Mol Psychiatry 2023. [PMID: 36869227 DOI: 10.1038/s41380-023-02006-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 03/05/2023]
Abstract
The racial/ethnic disparities in cancer incidence and outcome are partially due to the inequities in neighborhood advantage. Mounting evidences supported a link between neighborhood deprivation and cancer outcomes including higher mortality. In this review, we discuss some of the findings related to work on area-level neighborhood variables and cancer outcomes, and the potential biological and built/natural environmental mechanisms that might explain this link. Studies have also shown that residents of deprived neighborhoods or of racially or economically segregated neighborhoods have worse health outcomes than residents of more affluent neighborhoods and/or less racially or economically segregated neighborhoods, even after adjusting for the individual-level socioeconomic status. To date, little research has been conducted investigating the biological mediators that may play roles in the associations of neighborhood deprivation and segregation with cancer outcomes. The psychophysiological stress induced by neighborhood disadvantage among people living in these neighborhoods could be a potential underlying biological mechanism. We examined a number of chronic stress-related pathways that may potentially mediate the relationship between area-level neighborhood factors and cancer outcomes, including higher allostatic load, stress hormones, altered epigenome and telomere maintenance and biological aging. In conclusion, the extant evidence supports the notion that neighborhood deprivation and racial segregation have unfavorable impacts on cancer. Understanding how neighborhood factors influence the biological stress response has the potential to inform where and what types of resources are needed within the community to improve cancer outcomes and reduce disparities. More studies are warranted to directly assess the role of biological and social mechanisms in mediating the relationship between neighborhood factors and cancer outcomes.
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Connor AE, Dibble KE, Visvanathan K. Utilizing Social Media Advertisements and Participant Social Networks to Recruit African American Breast Cancer Survivors: Design and Rationale. Front Public Health 2022; 10:931102. [PMID: 35899153 PMCID: PMC9309894 DOI: 10.3389/fpubh.2022.931102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Our objective is to pilot an advertisement-driven sampling procedure among African American (AA) breast cancer survivors living in Maryland. These pilot study methods will inform a future population-based study of AA breast cancer survivors at high risk of poor outcomes due to biological differences and social inequities. Methods This cross-sectional study utilizes an innovative, social media-based advertisement campaign with an associated social media study page to recruit 100 AA breast cancer survivors. Participants are biologically female, aged 18 and older, identify as AA/Black, have a diagnosis of breast cancer, and reside in Maryland. A preset "Audience" was created via Meta (formerly Facebook) to automatically target potential interest in the online study via geolocation and public social media interests (estimated range = 101,000 women). Eligible participants complete an online survey including demographic and clinical characteristics, cancer screening, healthcare access, and utilization, COVID-19 impact, quality of doctor-patient communication, and preferences for future study participation. Results Recruitment began on 5 January 2022 and remains ongoing. As of 7 June 2002: 124 completed the screener, 110/124 (88.7%) consented passively, 24/110 (21.8%) started but did not complete survey, 86/110 (78.1%) completed the survey. Conclusions Results from this study will inform a statewide multilevel prospective population-based study to improve health behaviors, disease management, and self-efficacy of chronic disease management among AA breast cancer survivors.
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Affiliation(s)
- Avonne E Connor
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Kate E Dibble
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
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