title: Intersection of Race/Ethnicity and Socioeconomic Status in Mortality After Breast Cancer.
abstract: We investigated social disparities in breast cancer (BC) mortality, leveraging data from the California Breast Cancer Survivorship Consortium. The associations of race/ethnicity, education, and neighborhood SES (nSES) with all-cause and BC-specific mortality were assessed among 9372 women with BC (diagnosed 1993-2007 in California with follow-up through 2010) from four racial/ethnic groups [African American, Asian American, Latina, and non-Latina (NL) White] using Cox proportional hazards models. Compared to NL White women with high-education/high-nSES, higher all-cause mortality was observed among NL White women with high-education/low-nSES [hazard ratio (HR) (95 % confidence interval) 1.24 (1.08-1.43)], and African American women with low-nSES, regardless of education [high education HR 1.24 (1.03-1.49); low-education HR 1.19 (0.99-1.44)]. Latina women with low-education/high-nSES had lower all-cause mortality [HR 0.70 (0.54-0.90)] and non-significant lower mortality was observed for Asian American women, regardless of their education and nSES. Similar patterns were seen for BC-specific mortality. Individual- and neighborhood-level measures of SES interact with race/ethnicity to impact mortality after BC diagnosis. Considering the joint impacts of these social factors may offer insights to understanding inequalities by multiple social determinants of health.
authors.affiliation: Cancer Prevention Institute of California, 2201 Walnut Ave, Suite 300, Fremont, CA, 94538, USA. salma.shariff-marco@cpic.org.|Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, CA, USA. salma.shariff-marco@cpic.org.|Stanford Cancer Institute, Stanford, CA, USA. salma.shariff-marco@cpic.org.
authors.forename: Salma
authors.initials: S
authors.lastname: Shariff-Marco
authors.affiliation: Cancer Prevention Institute of California, 2201 Walnut Ave, Suite 300, Fremont, CA, 94538, USA.
authors.forename: Juan
authors.initials: J
authors.lastname: Yang
authors.affiliation: Cancer Prevention Institute of California, 2201 Walnut Ave, Suite 300, Fremont, CA, 94538, USA.|Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, CA, USA.|Stanford Cancer Institute, Stanford, CA, USA.
authors.forename: Esther M
authors.initials: EM
authors.lastname: John
authors.affiliation: Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, CA, USA.|Stanford Cancer Institute, Stanford, CA, USA.|Department of Medicine (Oncology), Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Allison W
authors.initials: AW
authors.lastname: Kurian
authors.affiliation: Cancer Prevention Institute of California, 2201 Walnut Ave, Suite 300, Fremont, CA, 94538, USA.|Stanford Cancer Institute, Stanford, CA, USA.
authors.forename: Iona
authors.initials: I
authors.lastname: Cheng
authors.affiliation: Cancer Prevention Institute of California, 2201 Walnut Ave, Suite 300, Fremont, CA, 94538, USA.
authors.forename: Rita
authors.initials: R
authors.lastname: Leung
authors.affiliation: Cancer Prevention Institute of California, 2201 Walnut Ave, Suite 300, Fremont, CA, 94538, USA.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Koo
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Kristine R
authors.initials: KR
authors.lastname: Monroe
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Henderson
authors.affiliation: Division of Cancer Etiology, Department of Population Sciences, Beckman Research Institute of the City of Hope and City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Bernstein
authors.affiliation: Division of Cancer Etiology, Beckman Research Institute of the City of Hope, Duarte, CA, USA.
authors.forename: Yani
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
authors.forename: Marilyn L
authors.initials: ML
authors.lastname: Kwan
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Sposto
authors.affiliation: Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA.
authors.forename: Cheryl L P
authors.initials: CL
authors.lastname: Vigen
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.|Cancer Control Research Program, USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA.
authors.forename: Anna H
authors.initials: AH
authors.lastname: Wu
authors.affiliation: Cancer Prevention Institute of California, 2201 Walnut Ave, Suite 300, Fremont, CA, 94538, USA.|Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, CA, USA.|Stanford Cancer Institute, Stanford, CA, USA.
authors.forename: Theresa H M
authors.initials: TH
authors.lastname: Keegan
authors.affiliation: Cancer Prevention Institute of California, 2201 Walnut Ave, Suite 300, Fremont, CA, 94538, USA.|Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, CA, USA.|Stanford Cancer Institute, Stanford, CA, USA.
authors.forename: Scarlett Lin
authors.initials: SL
authors.lastname: Gomez
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000428:Alcohol Drinking / Q000208:ethnology; D019883:Alkyl and Aryl Transferases; D001213:Asian; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000208:ethnology*; D002140:California / Q000453:epidemiology; D003576:Electron Transport Complex IV; D005260:Female; D015438:Health Behavior; D054624:Health Status Disparities; D006630:Hispanic or Latino; D006801:Humans; D008565:Membrane Proteins; D008875:Middle Aged; D012111:Residence Characteristics; D012907:Smoking / Q000208:ethnology; D012959:Socioeconomic Factors; D044465:White People
chemical_list: D008565:Membrane Proteins; C490115:COX10 protein, human; D003576:Electron Transport Complex IV; D019883:Alkyl and Aryl Transferases
keywords: Breast cancer survival; Education; Neighborhood socioeconomic status; Racial/ethnic disparities; Socioeconomic disparities