title: Impact of neighborhood and individual socioeconomic status on survival after breast cancer varies by race/ethnicity: the Neighborhood and Breast Cancer Study.
abstract: BACKGROUND
  Research is limited on the independent and joint effects of individual- and neighborhood-level socioeconomic status (SES) on breast cancer survival across different racial/ethnic groups.
  
  
  METHODS
  We studied individual-level SES, measured by self-reported education, and a composite neighborhood SES (nSES) measure in females (1,068 non-Hispanic whites, 1,670 Hispanics, 993 African-Americans, and 674 Asian-Americans), ages 18 to 79 years and diagnosed 1995 to 2008, in the San Francisco Bay Area. We evaluated all-cause and breast cancer-specific survival using stage-stratified Cox proportional hazards models with cluster adjustment for census block groups.
  
  
  RESULTS
  In models adjusting for education and nSES, lower nSES was associated with worse all-cause survival among African-Americans (P trend = 0.03), Hispanics (P trend = 0.01), and Asian-Americans (P trend = 0.01). Education was not associated with all-cause survival. For breast cancer-specific survival, lower nSES was associated with poorer survival only among Asian-Americans (P trend = 0.01). When nSES and education were jointly considered, women with low education and low nSES had 1.4 to 2.7 times worse all-cause survival than women with high education and high nSES across all races/ethnicities. Among African-Americans and Asian-Americans, women with high education and low nSES had 1.6 to 1.9 times worse survival, respectively. For breast cancer-specific survival, joint associations were found only among Asian-Americans with worse survival for those with low nSES regardless of education.
  
  
  CONCLUSIONS
  Both neighborhood and individual SES are associated with survival after breast cancer diagnosis, but these relationships vary by race/ethnicity.
  
  
  CONCLUSIONS
  A better understanding of the relative contributions and interactions of SES with other factors will inform targeted interventions toward reducing long-standing disparities in breast cancer survival.
authors.affiliation: Authors' Affiliations: Cancer Prevention Institute of California, Fremont; Stanford University, School of Medicine, Stanford; University of Southern California, School of Medicine, Los Angeles; University of California, Berkeley School of Public Health, Berkeley; University of California, San Francisco School of Medicine, San Francisco; and University of California, Los Angeles School of Public Health and Center for Health Policy Research, Los Angeles, California.
authors.forename: Salma
authors.initials: S
authors.lastname: Shariff-Marco
authors.forename: Juan
authors.initials: J
authors.lastname: Yang
authors.forename: Esther M
authors.initials: EM
authors.lastname: John
authors.forename: Meera
authors.initials: M
authors.lastname: Sangaramoorthy
authors.forename: Andrew
authors.initials: A
authors.lastname: Hertz
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Koo
authors.forename: David O
authors.initials: DO
authors.lastname: Nelson
authors.forename: Clayton W
authors.initials: CW
authors.lastname: Schupp
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Shema
authors.forename: Myles
authors.initials: M
authors.lastname: Cockburn
authors.forename: William A
authors.initials: WA
authors.lastname: Satariano
authors.forename: Irene H
authors.initials: IH
authors.lastname: Yen
authors.forename: Ninez A
authors.initials: NA
authors.lastname: Ponce
authors.forename: Marilyn
authors.initials: M
authors.lastname: Winkleby
authors.forename: Theresa H M
authors.initials: TH
authors.lastname: Keegan
authors.forename: Scarlett L
authors.initials: SL
authors.lastname: Gomez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000191:economics / Q000208:ethnology* / Q000401:mortality* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000208:ethnology / Q000401:mortality / Q000473:pathology; D018275:Carcinoma, Lobular / Q000208:ethnology / Q000401:mortality / Q000473:pathology; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D044469:Racial Groups / Q000706:statistics & numerical data*; D012495:San Francisco; D012923:Social Class; D012959:Socioeconomic Factors; D015996:Survival Rate; D055815:Young Adult