Impact of neighborhood and individual socioeconomic status on survival after breast cancer varies by race/ethnicity: The neighborhood and breast cancer study

Salma Shariff-Marco, Juan Yang, Esther M. John, Meera Sangaramoorthy, Andrew Hertz, Jocelyn Koo, David O. Nelson, Clayton W. Schupp, Sarah J. Shema, Myles Cockburn, William A. Satariano, Irene H. Yen, Ninez A. Ponce, Marilyn Winkleby, Theresa H Keegan, Scarlett L. Gomez

Research output: Contribution to journalArticle

42 Scopus citations


Background: Research is limited on the independent and joint effects of individual- and neighborhood-level socioeconomic status (SES) on breast cancer survival across different racial/ethnic groups. Methods: We studied individual-level SES, measured by self-reported education, and a composite neighborhood SES (nSES) measure in females (1,068 non-Hispanic whites, 1,670 Hispanics, 993 African-Americans, and 674 Asian-Americans), ages 18 to 79 years and diagnosed 1995 to 2008, in the San Francisco Bay Area. We evaluated all-cause and breast cancer-specific survival using stage-stratified Cox proportional hazards models with cluster adjustment for census block groups. Results: In models adjusting for education and nSES, lower nSES was associated with worse all-cause survival among African-Americans (Ptrend = 0.03), Hispanics (Ptrend = 0.01), and Asian-Americans (P trend = 0.01). Education was not associated with all-cause survival. For breast cancer-specific survival, lower nSES was associated with poorer survival only among Asian-Americans (Ptrend = 0.01). When nSES and education were jointly considered, women with low education and low nSES had 1.4 to 2.7 times worse all-cause survival than women with high education and high nSES across all races/ethnicities. Among African-Americans and Asian- Americans, women with high education and low nSES had 1.6 to 1.9 times worse survival, respectively. For breast cancer-specific survival, joint associations were found only among Asian-Americans with worse survival for those with low nSES regardless of education. Conclusions: Both neighborhood and individual SES are associated with survival after breast cancer diagnosis, but these relationships vary by race/ethnicity. Impact: A better understanding of the relative contributions and interactions of SES with other factors will inform targeted interventions toward reducing long-standing disparities in breast cancer survival.

Original languageEnglish (US)
Pages (from-to)793-811
Number of pages19
JournalCancer Epidemiology Biomarkers and Prevention
Issue number5
StatePublished - 2014
Externally publishedYes


ASJC Scopus subject areas

  • Epidemiology
  • Oncology

Cite this

Shariff-Marco, S., Yang, J., John, E. M., Sangaramoorthy, M., Hertz, A., Koo, J., Nelson, D. O., Schupp, C. W., Shema, S. J., Cockburn, M., Satariano, W. A., Yen, I. H., Ponce, N. A., Winkleby, M., Keegan, T. H., & Gomez, S. L. (2014). Impact of neighborhood and individual socioeconomic status on survival after breast cancer varies by race/ethnicity: The neighborhood and breast cancer study. Cancer Epidemiology Biomarkers and Prevention, 23(5), 793-811.