Abstract
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 language | English (US) |
|---|---|
| Pages (from-to) | 793-811 |
| Number of pages | 19 |
| Journal | Cancer Epidemiology Biomarkers and Prevention |
| Volume | 23 |
| Issue number | 5 |
| DOIs | |
| State | Published - 2014 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Epidemiology
- Oncology
Cite this
Impact of neighborhood and individual socioeconomic status on survival after breast cancer varies by race/ethnicity : The neighborhood and breast cancer study. / Shariff-Marco, Salma; Yang, Juan; John, Esther M.; Sangaramoorthy, Meera; Hertz, Andrew; Koo, Jocelyn; Nelson, David O.; Schupp, Clayton W.; Shema, Sarah J.; Cockburn, Myles; Satariano, William A.; Yen, Irene H.; Ponce, Ninez A.; Winkleby, Marilyn; Keegan, Theresa H; Gomez, Scarlett L.
In: Cancer Epidemiology Biomarkers and Prevention, Vol. 23, No. 5, 2014, p. 793-811.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Impact of neighborhood and individual socioeconomic status on survival after breast cancer varies by race/ethnicity
T2 - The neighborhood and breast cancer study
AU - Shariff-Marco, Salma
AU - Yang, Juan
AU - John, Esther M.
AU - Sangaramoorthy, Meera
AU - Hertz, Andrew
AU - Koo, Jocelyn
AU - Nelson, David O.
AU - Schupp, Clayton W.
AU - Shema, Sarah J.
AU - Cockburn, Myles
AU - Satariano, William A.
AU - Yen, Irene H.
AU - Ponce, Ninez A.
AU - Winkleby, Marilyn
AU - Keegan, Theresa H
AU - Gomez, Scarlett L.
PY - 2014
Y1 - 2014
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84899760198&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84899760198&partnerID=8YFLogxK
U2 - 10.1158/1055-9965.EPI-13-0924
DO - 10.1158/1055-9965.EPI-13-0924
M3 - Article
C2 - 24618999
AN - SCOPUS:84899760198
VL - 23
SP - 793
EP - 811
JO - Cancer Epidemiology Biomarkers and Prevention
JF - Cancer Epidemiology Biomarkers and Prevention
SN - 1055-9965
IS - 5
ER -