title: Impact of neighborhood racial composition and metropolitan residential segregation on disparities in breast cancer stage at diagnosis and survival between black and white women in California.
abstract: We examined the impact of metropolitan racial residential segregation on stage at diagnosis and all-cause and breast cancer-specific survival between and within black and white women diagnosed with breast cancer in California between 1996 and 2004. We merged data from the California Cancer Registry with Census indices of five dimensions of racial residential segregation, quantifying segregation among Blacks relative to Whites; block group ("neighborhood") measures of the percentage of Blacks and a composite measure of socioeconomic status. We also examined simultaneous segregation on at least two measures ("hypersegregation"). Using logistic regression we examined effects of these measures on stage at diagnosis and Cox proportional hazards regression for survival. For all-cause and breast-cancer specific mortality, living in neighborhoods with more Blacks was associated with lower mortality among black women, but higher mortality among Whites. However, neighborhood racial composition and metropolitan segregation did not explain differences in stage or survival between Black and White women. Future research should identify mechanisms by which these measures impact breast cancer diagnosis and outcomes among Black women.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Kresge Building, 677 Huntington Ave, 9th Floor, Boston, MA 02115, USA. ewarner@hsph.harvard.edu
authors.forename: Erica T
authors.initials: ET
authors.lastname: Warner
authors.forename: Scarlett Lin
authors.initials: SL
authors.lastname: Gomez
mesh_terms: D000328:Adult; D000368:Aged; D044383:Black People / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000473:pathology; D002140:California / Q000453:epidemiology; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012923:Social Class; D015996:Survival Rate; D014504:Urban Health; D014505:Urban Population / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American