title: The Effect of Patient and Contextual Characteristics on Racial/Ethnic Disparity in Breast Cancer Mortality.
abstract: Racial/ethnic disparity in breast cancer-specific mortality in the United States is well documented. We examined whether accounting for racial/ethnic differences in the prevalence of clinical, patient, and lifestyle and contextual factors that are associated with breast cancer-specific mortality can explain this disparity.
  
  
  
  The California Breast Cancer Survivorship Consortium combined interview data from six California-based breast cancer studies with cancer registry data to create a large, racially diverse cohort of women with primary invasive breast cancer. We examined the contribution of variables in a previously reported Cox regression baseline model plus additional contextual, physical activity, body size, and comorbidity variables to the racial/ethnic disparity in breast cancer-specific mortality.
  
  
  
  The cohort comprised 12,098 women. Fifty-four percent were non-Latina Whites, 17% African Americans, 17% Latinas, and 12% Asian Americans. In a model adjusting only for age and study, breast cancer-specific HRs relative to Whites were 1.69 (95% CI, 1.46-1.96), 1.00 (0.84-1.19), and 0.52 (0.33-0.85) for African Americans, Latinas, and Asian Americans, respectively. Adjusting for baseline-model variables decreased disparity primarily by reducing the HR for African Americans to 1.13 (0.96-1.33). The most influential variables were related to disease characteristics, neighborhood socioeconomic status, and smoking status at diagnosis. Other variables had negligible impact on disparity.
  
  
  
  Although contextual, physical activity, body size, and comorbidity variables may influence breast cancer-specific mortality, they do not explain racial/ethnic mortality disparity.
  
  
  
  Other factors besides those investigated here may explain the existing racial/ethnic disparity in mortality. Cancer Epidemiol Biomarkers Prev; 25(7); 1064-72. ©2016 AACR.
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California. Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California. rsposto@chla.usc.edu.
authors.forename: Richard
authors.initials: R
authors.lastname: Sposto
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, UC Davis Comprehensive Cancer Center, Sacramento, California.
authors.forename: Theresa H M
authors.initials: TH
authors.lastname: Keegan
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Vigen
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors.forename: Marilyn L
authors.initials: ML
authors.lastname: Kwan
authors.affiliation: City of Hope, Duarte, California.
authors.forename: Leslie
authors.initials: L
authors.lastname: Bernstein
authors.affiliation: Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California. Stanford University School of Medicine, Stanford, California.
authors.forename: Esther M
authors.initials: EM
authors.lastname: John
authors.affiliation: Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California.
authors.forename: Iona
authors.initials: I
authors.lastname: Cheng
authors.affiliation: Cancer Prevention Institute of California, Fremont, California.
authors.forename: Juan
authors.initials: J
authors.lastname: Yang
authors.affiliation: Cancer Prevention Institute of California, Fremont, California.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Koo
authors.affiliation: Stanford Cancer Institute, Stanford, California. Stanford University School of Medicine, Stanford, California.
authors.forename: Allison W
authors.initials: AW
authors.lastname: Kurian
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors.forename: Bette J
authors.initials: BJ
authors.lastname: Caan
authors.affiliation: City of Hope, Duarte, California.
authors.forename: Yani
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Kristine R
authors.initials: KR
authors.lastname: Monroe
authors.affiliation: Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California. Stanford University School of Medicine, Stanford, California.
authors.forename: Salma
authors.initials: S
authors.lastname: Shariff-Marco
authors.affiliation: Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California. Stanford University School of Medicine, Stanford, California.
authors.forename: Scarlett Lin
authors.initials: SL
authors.lastname: Gomez
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Anna H
authors.initials: AH
authors.lastname: Wu
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D001213:Asian / Q000706:statistics & numerical data; D049628:Body Size; D001943:Breast Neoplasms / Q000208:ethnology / Q000401:mortality*; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D015444:Exercise; D005260:Female; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D016016:Proportional Hazards Models; D012307:Risk Factors; D044465:White People / Q000706:statistics & numerical data