title: Residential Segregation and Racial Cancer Disparities: A Systematic Review.
abstract: This paper provides the first review of empirical studies of segregation and black-white cancer disparities.
  
  
  
  We searched all years of PubMed (through May 2016) using these terms: racial segregation, residential segregation, neighborhood racial composition (first terms) and (second terms) cancer incidence, mortality, survival, stage at diagnosis, screening. The 17 (of 668) articles that measured both segregation and a cancer outcome were retained.
  
  
  
  Segregation contributed significantly to cancer and to racial cancer disparities in 70% of analyses, even after controlling for socioeconomic status and health insurance. Residing in segregated African-American areas was associated with higher odds of later-stage diagnosis of breast and lung cancers, higher mortality rates and lower survival rates from breast and lung cancers, and higher cumulative cancer risks associated with exposure to ambient air toxics. There were no studies of many types of cancer (e.g., cervical). Studies differed in their measure of segregation, and 40% used an invalid measure. Possible mediators of the segregation effect usually were not tested.
  
  
  
  Empirical analysis of segregation and racial cancer disparities is a recent area of research. The literature is limited to 17 studies that focused primarily on breast cancer. Studies differed in their measure of segregation, yet segregation nonetheless contributed to cancer and to racial cancer disparities in 70% of analyses. This suggests the need for further research that uses valid measures of segregation, examines a variety of types of cancers, and explores the variables that may mediate the segregation effect.
authors.affiliation: Center for Health Disparities, Brody School of Medicine, East Carolina University, 1800 W. 5th Street, Medical Pavilion Suite 6, Greenville, NC, 27858, USA. landrineh@ecu.edu.
authors.forename: Hope
authors.identifier: 0000-0003-4774-1108
authors.initials: H
authors.lastname: Landrine
authors.affiliation: Department of Psychiatry and Behavioral Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
authors.forename: Irma
authors.initials: I
authors.lastname: Corral
authors.affiliation: Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA.
authors.forename: Joseph G L
authors.initials: JGL
authors.lastname: Lee
authors.affiliation: Department of Cardiovascular Sciences and Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
authors.forename: Jimmy T
authors.initials: JT
authors.lastname: Efird
authors.affiliation: Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
authors.forename: Marla B
authors.initials: MB
authors.lastname: Hall
authors.affiliation: Center for Health Disparities, Brody School of Medicine, East Carolina University, 1800 W. 5th Street, Medical Pavilion Suite 6, Greenville, NC, 27858, USA.
authors.forename: Jukelia J
authors.initials: JJ
authors.lastname: Bess
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006801:Humans; D009369:Neoplasms / Q000208:ethnology*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D000072699:Social Segregation; D044465:White People / Q000706:statistics & numerical data*
keywords: African-Americans; Blacks; Cancer; Cancer disparities; Race; Residential segregation; Whites