title: Neighborhood socioeconomic deprivation, tumor subtypes, and causes of death after non-metastatic invasive breast cancer diagnosis: a multilevel competing-risk analysis.
abstract: The purpose of this study is to examine the associations of neighborhood socioeconomic deprivation and triple-negative breast cancer (TNBC) subtype with causes of death [breast cancer (BC)-specific and non-BC-specific] among non-metastatic invasive BC patients. We identified 3,312 patients younger than 75 years (mean age 53.5 years; 621 [18.8 %] TNBC) with first primary BC treated at an academic medical center from 1999 to 2010. We constructed a census-tract-level socioeconomic deprivation index using the 2000 U.S. Census data and performed a multilevel competing-risk analysis to estimate the hazard ratios (HR) and 95 % confidence intervals (CI) of BC-specific and non-BC-specific mortality associated with neighborhood socioeconomic deprivation and TNBC subtype. The adjusted models controlled for patient sociodemographics, health behaviors, tumor characteristics, comorbidity, and cancer treatment. With a median 62-month follow-up, 349 (10.5 %) patients died; 233 died from BC. In the multivariate models, neighborhood socioeconomic deprivation was independently associated with non-BC-specific mortality (the most- vs. the least-deprived quartile: HR = 2.98, 95 % CI = 1.33-6.66); in contrast, its association with BC-specific mortality was explained by the aforementioned patient-level covariates, particularly sociodemographic factors (HR = 1.15, 95 % CI = 0.71-1.87). TNBC subtype was independently associated with non-BC-specific mortality (HR = 2.15; 95 % CI = 1.20-3.84), while the association between TNBC and BC-specific mortality approached significance (HR = 1.42; 95 % CI = 0.99-2.03, P = 0.057). Non-metastatic invasive BC patients who lived in more socioeconomically deprived neighborhoods were more likely to die as a result of causes other than BC compared with those living in the least socioeconomically deprived neighborhoods. TNBC was associated with non-BC-specific mortality but not BC-specific mortality.
authors.affiliation: Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, Campus Box 8005, St. Louis, MO, 63110, USA, mlian@wustl.edu.
authors.forename: Min
authors.initials: M
authors.lastname: Lian
authors.forename: Maria
authors.initials: M
authors.lastname: Pérez
authors.forename: Ying
authors.initials: Y
authors.lastname: Liu
authors.forename: Mario
authors.initials: M
authors.lastname: Schootman
authors.forename: Ann
authors.initials: A
authors.lastname: Frisse
authors.forename: Ellen
authors.initials: E
authors.lastname: Foldes
authors.forename: Donna B
authors.initials: DB
authors.lastname: Jeffe
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D006801:Humans; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D015999:Multivariate Analysis; D012111:Residence Characteristics; D012307:Risk Factors; D012959:Socioeconomic Factors; D015996:Survival Rate; D064726:Triple Negative Breast Neoplasms / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality; D055815:Young Adult