title: Racial/Ethnic Differences in the Impact of Neighborhood Social and Built Environment on Breast Cancer Risk: The Neighborhoods and Breast Cancer Study.
abstract: Background:Neighborhood socioeconomic status (nSES) has been found to be associated with breast cancer risk. It remains unclear whether this association applies across racial/ethnic groups independent of individual-level factors and is attributable to other neighborhood characteristics.Methods:We examined the independent and joint associations of education and nSES with odds of breast cancer. Residential addresses were geocoded for 2,838 cases and 3,117 controls and linked to nSES and social and built environment characteristics. We estimated ORs and 95% confidence intervals (CI) using multilevel logistic regression controlling for individual-level breast cancer risk factors and assessed the extent to which nSES associations were due to neighborhood characteristics.Results:Women living in the highest versus lowest nSES quintile had a nearly 2-fold greater odds of breast cancer, with elevated odds (adjusted ORs, 95% CI) for non-Hispanic whites (NHWs; 2.27; 1.45-3.56), African Americans (1.74; 1.07-2.83), U.S.-born Hispanics (1.82; 1.19-2.79), and foreign-born Hispanics (1.83; 1.06-3.17). Considering education and nSES jointly, ORs were increased for low education/high nSES NHWs (1.83; 1.14-2.95), high education/high nSES NHWs (1.64; 1.06-2.54), and high education/high nSES foreign-born Hispanics (2.17; 1.52-3.09) relative to their race/ethnicity/nativity-specific low education/low nSES counterparts. Adjustment for urban and mixed-land use characteristics attenuated the nSES associations for most racial/ethnic/nativity groups except NHWs.Conclusions:Our study provides empirical evidence for a role of neighborhood environments in breast cancer risk, specifically social and built environment attributes.Impact:Considering the role of neighborhood characteristics among diverse populations may offer insights to understand racial/ethnic disparities in breast cancer risk.Cancer Epidemiol Biomarkers Prev; 26(4); 541-52. ©2017 AACR.
authors.affiliation: Cancer Prevention Institute of California, Fremont, California.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Conroy
authors.affiliation: Cancer Prevention Institute of California, Fremont, California.|Department of Health Research and Policy (Epidemiology) and Stanford Cancer Institute, 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.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Koo
authors.affiliation: Cancer Prevention Institute of California, Fremont, California.
authors.forename: Juan
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, California.
authors.forename: Theresa H M
authors.initials: TH
authors.lastname: Keegan
authors.affiliation: Cancer Prevention Institute of California, Fremont, California.
authors.forename: Meera
authors.initials: M
authors.lastname: Sangaramoorthy
authors.affiliation: Cancer Prevention Institute of California, Fremont, California.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hertz
authors.affiliation: Cancer Prevention Institute of California, Fremont, California.|Department of Health Research and Policy (Epidemiology) and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California.
authors.forename: David O
authors.initials: DO
authors.lastname: Nelson
authors.affiliation: Colorado School of Public Health, University of Colorado, Denver, Colorado.
authors.forename: Myles
authors.initials: M
authors.lastname: Cockburn
authors.affiliation: School of Public Health, University of California, Berkeley, Berkeley, California.
authors.forename: William A
authors.initials: WA
authors.lastname: Satariano
authors.affiliation: Department of Medicine and Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: Irene H
authors.initials: IH
authors.lastname: Yen
authors.affiliation: Department of Health Policy and Management, University of California, Los Angeles Fielding School of Public Health and Center for Health Policy Research, Los Angeles, California.
authors.forename: Ninez A
authors.initials: NA
authors.lastname: Ponce
authors.affiliation: Cancer Prevention Institute of California, Fremont, California.|Department of Health Research and Policy (Epidemiology) and Stanford Cancer Institute, 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. Scarlett.Gomez@cpic.org.|Department of Health Research and Policy (Epidemiology) and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California.
authors.forename: Scarlett Lin
authors.initials: SL
authors.lastname: Gomez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000208:ethnology*; D002140:California; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D044469:Racial Groups / Q000706:statistics & numerical data*; D012042:Registries; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012923:Social Class; D011795:Surveys and Questionnaires; D055815:Young Adult