title: Racial differences in breast cancer survival in a large urban integrated health system.
abstract: BACKGROUND
  African American (AA) women are known to have poorer breast cancer survival than whites, and the differences may be related to underlying disparities in their clinical presentation or access to care. This study evaluated the relationship between demographic, treatment, and socioeconomic factors and breast cancer survival among women in southeast Michigan.
  
  
  METHODS
  The population included 2387 women (34% AA) with American Joint Committee on Cancer stage I to III breast cancer who were treated at the Henry Ford Health System (HFHS) from 1996 through 2005. Linked data sets from the HFHS, the Metropolitan Detroit Cancer Surveillance System, and the US Census Bureau were used to obtain demographic and clinical information. Comorbidities were classified with the modified Charlson comorbidity index (CCI). Economic deprivation was categorized with a census tract-based deprivation index (DI), which was stratified into 5 quintiles of increasing socioeconomic disadvantage.
  
  
  RESULTS
  Compared with whites, AA women were significantly more likely to have larger, hormone receptor-negative tumors and more comorbidities and to reside in an economically deprived area. In an unadjusted analysis, AAs had a significantly higher risk of death (hazard ratio [HR], 1.36; 95% confidence interval [CI], 1.16-1.59); however, after adjustments for clinical (age, stage, hormone receptor, and CCI) and societal factors (DI), the effect of race was not significant (HR, 1.13 [95% CI, 0.96-1.34] , and HR, 0.97 [0.80-1.19] respectively).
  
  
  CONCLUSIONS
  Racial differences in breast cancer survival can be explained by clinical and socioeconomic factors. Nonetheless, AA women with breast cancer remain disproportionately affected by unfavorable tumor characteristics and economic deprivation, which likely contribute to their increased overall mortality.
authors.affiliation: Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Molly E
authors.initials: ME
authors.lastname: Roseland
authors.affiliation: Columbia St. Mary's Family Health Center, Milwaukee, Wisconsin.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Pressler
authors.affiliation: Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan.
authors.forename: Lois E
authors.initials: LE
authors.lastname: Lamerato
authors.affiliation: Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan.
authors.forename: Rick
authors.initials: R
authors.lastname: Krajenta
authors.affiliation: Karmanos Cancer Institute/Department of Oncology, Wayne State University, Detroit, Michigan.|Population Studies and Prevention Program, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan.
authors.forename: Julie J
authors.initials: JJ
authors.lastname: Ruterbusch
authors.affiliation: Wayne State University School of Medicine, Detroit, Michigan.|Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Booza
authors.affiliation: Wayne State University School of Medicine, Detroit, Michigan.|Population Studies and Prevention Program, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan.|Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan.
authors.forename: Kendra
authors.initials: K
authors.lastname: Schwartz
authors.affiliation: Karmanos Cancer Institute/Department of Oncology, Wayne State University, Detroit, Michigan.|Population Studies and Prevention Program, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Simon
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000191:economics / Q000208:ethnology* / Q000401:mortality* / Q000473:pathology; D019033:Delivery of Health Care, Integrated; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008824:Michigan / Q000453:epidemiology / Q000208:ethnology; D018570:Risk Assessment; D012959:Socioeconomic Factors; D015996:Survival Rate / Q000639:trends; D019037:Urban Health Services; D044465:White People / Q000706:statistics & numerical data
keywords: African Americans; breast cancer; health care disparities; race; socioeconomic status; survival