title: Racial disparities in breast cancer mortality in a multiethnic cohort in the Southeast.
abstract: BACKGROUND
  Although much has been done to examine those factors associated with higher mortality among African American women, there is a paucity of literature that examines disparities among rural African Americans in South Carolina. The purpose of this investigation was to examine the association of race and mortality among breast cancer patients in a large cohort residing in South Carolina for which treatment regimens are standardized for all patients.
  
  
  METHODS
  Subjects included 1209 women diagnosed with breast cancer between 2000 and 2002 at a large, local hospital containing a comprehensive breast center. Kaplan-Meier survival curves were calculated to determine survival rates among African American and European American women, stratified by disease stage or other prognostic characteristics. Adjusting for various characteristics, Cox multivariate survival models were used to estimate the hazard ratio (HR).
  
  
  RESULTS
  The 5-year overall all-cause mortality survival proportion was ∼78% for African American women and ∼89% for European American women, P < 0.01. In analyses of subpopulations of women with identical disease characteristics, African American women had significantly higher mortality than European American women for the same type of breast cancer disease. In multivariate models, African American women had significantly higher mortality than European American women for both breast cancer-specific death (HR, 2.41; 95% confidence interval [CI], 1.21-4.79) and all-cause mortality (HR, 1.42; 95% CI, 1.06-1.89).
  
  
  CONCLUSIONS
  African American women residing in rural South Carolina had lower survival for breast cancer even after adjustment for disease-related prognostic characteristics. These findings support health interventions among African American breast cancer patients aimed at tertiary prevention strategies or further down-staging of disease at diagnosis.
authors.affiliation: College of Nursing, University of South Carolina, Columbia, SC, USA. swann.adams@sc.edu
authors.forename: Swann Arp
authors.initials: SA
authors.lastname: Adams
authors.forename: William M
authors.initials: WM
authors.lastname: Butler
authors.forename: Jeanette
authors.initials: J
authors.lastname: Fulton
authors.forename: Sue P
authors.initials: SP
authors.lastname: Heiney
authors.forename: Edith M
authors.initials: EM
authors.lastname: Williams
authors.forename: Alexandria F
authors.initials: AF
authors.lastname: Delage
authors.forename: Leepao
authors.initials: L
authors.lastname: Khang
authors.forename: James R
authors.initials: JR
authors.lastname: Hebert
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000208:ethnology* / Q000209:etiology / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D044465:White People