title: Residential segregation and disparities in health-related quality of life among Black and White cancer survivors.
abstract: OBJECTIVE
  Studies of health-related quality of life (HRQOL) among Black and White cancer survivors have been based on small convenience samples and yielded inconsistent results. We examined Black-White disparities in survivors' HRQOL with a population-based sample, and tested the hypothesis that area-level segregation accounts for those disparities.
  
  
  METHODS
  A sample of survivors of 10 types of cancer was drawn from 11 U.S. state cancer registries and surveyed 12-15 months after diagnosis. The current sample consisted of 5195 survivors (415 Black, 4780 White) who resided in 584 counties.
  
  
  METHODS
  SF-36 General Health subscale scores were used as the measure of HRQOL.
  
  
  RESULTS
  Bivariate results revealed that Black survivors had significantly poorer HRQOL than did White survivors. Multilevel regression including individual-level (gender, age, marital status, education, cancer type, stage at diagnosis, cancer progression, comorbidities, race/ethnicity) and area-level (county segregation and poverty) variables found that HRQOL was poorer among survivors who resided in high-Black-segregated counties, whereas race/ethnicity was no longer significant.
  
  
  CONCLUSIONS
  These findings indicate that Black-White disparities in HRQOL among cancer survivors might be a function, not of race/ethnicity, but of area-level variables associated with race/ethnicity. The strong role of segregation highlights the need for interventions to target Black-segregated areas.
authors.affiliation: Centers for Public Health Research and Evaluation, Battelle, Atlanta, Georgia, USA.
authors.forename: Yongping
authors.initials: Y
authors.lastname: Hao
authors.forename: Hope
authors.initials: H
authors.lastname: Landrine
authors.forename: Tenbroeck
authors.initials: T
authors.lastname: Smith
authors.forename: Chiewkwei
authors.initials: C
authors.lastname: Kaw
authors.forename: Irma
authors.initials: I
authors.lastname: Corral
authors.forename: Kevin
authors.initials: K
authors.lastname: Stein
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D011287:Prejudice; D011788:Quality of Life; D012044:Regression Analysis; D012111:Residence Characteristics; D011795:Surveys and Questionnaires; D017741:Survivors; D014481:United States; D044465:White People; D055815:Young Adult