TY - JOUR
T1 - The effect of patient and contextual characteristics on racial/ethnic disparity in breast cancer mortality
AU - Sposto, Richard
AU - Keegan, Theresa H M
AU - Vigen, Cheryl
AU - Kwan, Marilyn L.
AU - Bernstein, Leslie
AU - John, Esther M.
AU - Cheng, Iona
AU - Yang, Juan
AU - Koo, Jocelyn
AU - Kurian, Allison W.
AU - Caan, Bette J.
AU - Lu, Yani
AU - Monroe, Kristine R.
AU - Shariff-Marco, Salma
AU - Gomez, Scarlett Lin
AU - Wu, Anna H.
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Background: 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. Methods: 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. Results: 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. Conclusions: Although contextual, physical activity, body size, and comorbidity variables may influence breast cancer-specific mortality, they do not explain racial/ethnic mortality disparity. Impact: Other factors besides those investigated here may explain the existing racial/ethnic disparity in mortality.
AB - Background: 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. Methods: 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. Results: 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. Conclusions: Although contextual, physical activity, body size, and comorbidity variables may influence breast cancer-specific mortality, they do not explain racial/ethnic mortality disparity. Impact: Other factors besides those investigated here may explain the existing racial/ethnic disparity in mortality.
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U2 - 10.1158/1055-9965.EPI-15-1326
DO - 10.1158/1055-9965.EPI-15-1326
M3 - Article
C2 - 27197297
AN - SCOPUS:84977156644
VL - 25
SP - 1064
EP - 1072
JO - Cancer Epidemiology Biomarkers and Prevention
JF - Cancer Epidemiology Biomarkers and Prevention
SN - 1055-9965
IS - 7
ER -