title: The racial disparity in breast cancer mortality in the 25 largest cities in the United States.
abstract: BACKGROUND
  Although the racial disparity in breast cancer mortality is widely discussed there are no studies that analyze this phenomenon at the city level.
  
  
  METHODS
  We used national death files, abstracting those cases for which the cause was malignant neoplasm of the breast (ICD-10=C50) for the numerators and American Community Survey data for the denominators. The 25 largest cities in the US were the units of analysis. Non-Hispanic Black:non-Hispanic White rate ratios (RRs) were calculated, along with their confidence intervals, as measures of the racial disparity. Seven ecological (city-level) variables were examined as possible correlates.
  
  
  RESULTS
  Almost all the NHB rates were greater than almost all the NHW rates. All but 3 of the RRs (range 0.78-2.09; median=1.44) were >1, 13 of them significantly so. None of the RRs<1 were significant. From among the 7 potential correlates, only median household income (r=-0.43, p=0.037) and a measure of segregation (r=0.42, r=0.039) were significantly related to the RR.
  
  
  CONCLUSIONS
  This is the first study that we have been able to locate which examines city-level racial disparities in breast cancer mortality. The results are of concern for several cities and for the field in general. A strategy for reducing this disparity in Chicago is in place and may serve as a model for other cities wanting to initiate a similar process. Clearly it is time to take action.
authors.affiliation: Sinai Urban Health Institute, Mount Sinai Hospital, Chicago, IL 60608-1797, USA. Steve.Whitman@sinai.org
authors.forename: Steven
authors.initials: S
authors.lastname: Whitman
authors.forename: Jennifer
authors.initials: J
authors.lastname: Orsi
authors.forename: Marc
authors.initials: M
authors.lastname: Hurlbert
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000208:ethnology* / Q000401:mortality*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D014481:United States / Q000208:ethnology; D044465:White People / Q000706:statistics & numerical data