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Regional and racial disparities in breast cancer-specific mortality.

Abstract

Where and how one lives is associated with cancer survival. This study was designed to assess geographical region of residence, race/ethnicity, and clinical and socioeconomic factors as predictors of survival in a population based cohort of women with breast cancer followed for up to 12 years. In a cohort of 218,879 breast cancer patients >20 years of age at diagnosis, registered in the database of the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program between 1990 and 2001, we analyzed the association of breast cancer-specific survival with SEER region; age; stage; histology; hormone receptor status; race/ethnicity; and census data on educational attainment, income, employment, and insurance coverage. We compared Kaplan-Meier survival curves by region and race/ethnicity. We used Cox proportional hazards regression models to assess the association of mortality with region, race/ethnicity, and the other variables. Women who lived in Detroit had significantly higher mortality than those living in most other SEER regions. In most regions, black women had the poorest survival. The association of mortality with race did not differ significantly across regions, but it was significantly stronger among women 50-64 years of age than among women 65 and older. The SEER data document the association of breast cancer mortality with region, race, and socioeconomic status. Black race was a strong predictor of mortality in each region even after controlling for socioeconomic factors. The diminishing effect of race with age, which may only partially be explained by insurance in those over 65, suggests a need for research on the role of other factors, such as comorbid conditions or access to care, in breast cancer mortality.

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  • Authors+Show Affiliations

    ,

    Department of Medicine, Columbia University, New York, NY 10021, USA. vrg2@columbia.edu

    , , , ,

    Source

    Social science & medicine (1982) 62:2 2006 Jan pg 337-47

    MeSH

    Adult
    African Americans
    Age Distribution
    Aged
    Aged, 80 and over
    Breast Neoplasms
    Cohort Studies
    European Continental Ancestry Group
    Female
    Geography
    Humans
    Michigan
    Middle Aged
    Poverty Areas
    Proportional Hazards Models
    Risk Assessment
    SEER Program
    Socioeconomic Factors
    Survival Analysis
    United States
    Women's Health

    Pub Type(s)

    Comparative Study
    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    16051406

    Citation

    Grann, Victor, et al. "Regional and Racial Disparities in Breast Cancer-specific Mortality." Social Science & Medicine (1982), vol. 62, no. 2, 2006, pp. 337-47.
    Grann V, Troxel AB, Zojwalla N, et al. Regional and racial disparities in breast cancer-specific mortality. Soc Sci Med. 2006;62(2):337-47.
    Grann, V., Troxel, A. B., Zojwalla, N., Hershman, D., Glied, S. A., & Jacobson, J. S. (2006). Regional and racial disparities in breast cancer-specific mortality. Social Science & Medicine (1982), 62(2), pp. 337-47.
    Grann V, et al. Regional and Racial Disparities in Breast Cancer-specific Mortality. Soc Sci Med. 2006;62(2):337-47. PubMed PMID: 16051406.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Regional and racial disparities in breast cancer-specific mortality. AU - Grann,Victor, AU - Troxel,Andrea B, AU - Zojwalla,Naseem, AU - Hershman,Dawn, AU - Glied,Sherry A, AU - Jacobson,Judith S, Y1 - 2005/07/26/ PY - 2004/08/10/received PY - 2005/7/30/pubmed PY - 2006/6/7/medline PY - 2005/7/30/entrez SP - 337 EP - 47 JF - Social science & medicine (1982) JO - Soc Sci Med VL - 62 IS - 2 N2 - Where and how one lives is associated with cancer survival. This study was designed to assess geographical region of residence, race/ethnicity, and clinical and socioeconomic factors as predictors of survival in a population based cohort of women with breast cancer followed for up to 12 years. In a cohort of 218,879 breast cancer patients >20 years of age at diagnosis, registered in the database of the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program between 1990 and 2001, we analyzed the association of breast cancer-specific survival with SEER region; age; stage; histology; hormone receptor status; race/ethnicity; and census data on educational attainment, income, employment, and insurance coverage. We compared Kaplan-Meier survival curves by region and race/ethnicity. We used Cox proportional hazards regression models to assess the association of mortality with region, race/ethnicity, and the other variables. Women who lived in Detroit had significantly higher mortality than those living in most other SEER regions. In most regions, black women had the poorest survival. The association of mortality with race did not differ significantly across regions, but it was significantly stronger among women 50-64 years of age than among women 65 and older. The SEER data document the association of breast cancer mortality with region, race, and socioeconomic status. Black race was a strong predictor of mortality in each region even after controlling for socioeconomic factors. The diminishing effect of race with age, which may only partially be explained by insurance in those over 65, suggests a need for research on the role of other factors, such as comorbid conditions or access to care, in breast cancer mortality. SN - 0277-9536 UR - https://www.unboundmedicine.com/medline/citation/16051406/Regional_and_racial_disparities_in_breast_cancer_specific_mortality_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0277-9536(05)00298-4 DB - PRIME DP - Unbound Medicine ER -