title: Racial/ethnic and socioeconomic differences in short-term breast cancer survival among women in an integrated health system.
abstract: OBJECTIVE
  We examined the combined influence of race/ethnicity and neighborhood socioeconomic status (SES) on short-term survival among women with uniform access to health care and treatment.
  
  
  METHODS
  Using electronic medical records data from Kaiser Permanente Northern California linked to data from the California Cancer Registry, we included 6262 women newly diagnosed with invasive breast cancer. We analyzed survival using multivariable Cox proportional hazards regression with follow-up through 2010.
  
  
  RESULTS
  After consideration of tumor stage, subtype, comorbidity, and type of treatment received, non-Hispanic White women living in low-SES neighborhoods (hazard ratio [HR] = 1.28; 95% confidence interval [CI] = 1.07, 1.52) and African Americans regardless of neighborhood SES (high SES: HR = 1.44; 95% CI = 1.01, 2.07; low SES: HR = 1.88; 95% CI = 1.42, 2.50) had worse overall survival than did non-Hispanic White women living in high-SES neighborhoods. Results were similar for breast cancer-specific survival, except that African Americans and non-Hispanic Whites living in high-SES neighborhoods had similar survival.
  
  
  CONCLUSIONS
  Strategies to address the underlying factors that may influence treatment intensity and adherence, such as comorbidities and logistical barriers, should be targeted at low-SES non-Hispanic White and all African American patients.
authors: Theresa H. M. Keegan, Li Tao, Daphne Y. Lichtensztajn, and Scarlett L. Gomez are with the Cancer Prevention Institute of California, Fremont. Allison W. Kurian is with the Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA. Kathleen Gali is with the School of Social Sciences, Humanities and Arts, University of California, Merced. Dawn L. Hershman is with the Columbia University Medical Center, New York, NY. Laurel A. Habel and Bette J. Caan are with the Division of Research, Kaiser Permanente, Oakland, CA.
authors: Theresa H M
authors: TH
authors: Keegan
authors: Allison W
authors: AW
authors: Kurian
authors: Kathleen
authors: K
authors: Gali
authors: Li
authors: L
authors: Tao
authors: Daphne Y
authors: DY
authors: Lichtensztajn
authors: Dawn L
authors: DL
authors: Hershman
authors: Laurel A
authors: LA
authors: Habel
authors: Bette J
authors: BJ
authors: Caan
authors: Scarlett L
authors: SL
authors: Gomez
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000208:ethnology* / Q000401:mortality* / Q000628:therapy; D002140:California / Q000453:epidemiology; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D044469:Racial Groups / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D044465:White People / Q000706:statistics & numerical data