title: Increasing Black:White disparities in breast cancer mortality in the 50 largest cities in the United States.
abstract: BACKGROUND
  This paper presents race-specific breast cancer mortality rates and the corresponding rate ratios for the 50 largest U.S. cities for each of the 5-year intervals between 1990 and 2009.
  
  
  METHODS
  The 50 largest cities in the U.S. were the units of analysis. Numerator data were abstracted from national death files where the cause was malignant neoplasm of the breast (ICD-9=174 and ICD-10=C50) for women. Population-based denominators were obtained from the U.S. Census Bureau for 1990, 2000, and 2010. To measure the racial disparity, we calculated non-Hispanic Black:non-Hispanic White rate ratios (RRs) and confidence intervals for each 5-year period.
  
  
  RESULTS
  At the final time point (2005-2009), two RRs were less than 1, but neither significantly so, while 39 RRs were >1, 23 of them significantly so. Of the 41 cities included in the analysis, 35 saw an increase in the Black:White RR between 1990-1994 and 2005-2009. In many of the cities, the increase in the disparity occurred because White rates improved substantially over the 20-year study period, while Black rates did not. There were 1710 excess Black deaths annually due to this disparity in breast cancer mortality, for an average of about 5 each day.
  
  
  CONCLUSIONS
  This analysis revealed large and growing disparities in Black:White breast cancer mortality in the U.S. and many of its largest cities during the period 1990-2009. Much work remains to achieve equality in breast cancer mortality outcomes.
authors.affiliation: Sinai Urban Health Institute, Room K443, Mount Sinai Hospital, 1500 South California Avenue, Chicago, IL 60608-1797, USA. Electronic address: Bijou.Hunt@sinai.org.
authors.forename: Bijou R
authors.initials: BR
authors.lastname: Hunt
authors.affiliation: Sinai Urban Health Institute, Room K437, Mount Sinai Hospital, 1500 South California Avenue, Chicago, IL 60608-1797, USA. Electronic address: Steve.Whitman@sinai.org.
authors.forename: Steve
authors.initials: S
authors.lastname: Whitman
authors.affiliation: Avon Foundation Breast Cancer Crusade, 777 Third Avenue, New York, NY 10017, USA. Electronic address: Marc.Hurlbert@avonfoundation.org.
authors.forename: Marc S
authors.initials: MS
authors.lastname: Hurlbert
mesh_terms: D044383:Black People / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000208:ethnology* / Q000401:mortality*; D002947:Cities / Q000453:epidemiology; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American
keywords: Big cities; Breast cancer; Racial disparities