Regional and racial disparities in breast cancer-specific mortality

Victor Grann, Andrea B. Troxel, Naseem Zojwalla, Dawn Hershman, Sharon Glied, Judith S. Jacobson

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)337-347
Number of pages11
JournalSocial Science and Medicine
Volume62
Issue number2
DOIs
StatePublished - Jan 2006

Fingerprint

racial disparity
cancer
mortality
Breast Neoplasms
Mortality
epidemiology
ethnicity
surveillance
Epidemiology
Survival
socioeconomic factors
SEER Program
educational attainment
Insurance Coverage
socioeconomic status
National Cancer Institute (U.S.)
Regional disparities
Racial disparities
Breast cancer
Breast Cancer

Keywords

  • Breast cancer-specific mortality
  • Geographical region
  • Race/ethnicity
  • SEER database
  • Socioeconomic factors
  • United States

ASJC Scopus subject areas

  • Economics and Econometrics
  • Public Health, Environmental and Occupational Health
  • Social Psychology
  • Development
  • Health(social science)

Cite this

Regional and racial disparities in breast cancer-specific mortality. / Grann, Victor; Troxel, Andrea B.; Zojwalla, Naseem; Hershman, Dawn; Glied, Sharon; Jacobson, Judith S.

In: Social Science and Medicine, Vol. 62, No. 2, 01.2006, p. 337-347.

Research output: Contribution to journalArticle

Grann, V, Troxel, AB, Zojwalla, N, Hershman, D, Glied, S & Jacobson, JS 2006, 'Regional and racial disparities in breast cancer-specific mortality', Social Science and Medicine, vol. 62, no. 2, pp. 337-347. https://doi.org/10.1016/j.socscimed.2005.06.038
Grann, Victor ; Troxel, Andrea B. ; Zojwalla, Naseem ; Hershman, Dawn ; Glied, Sharon ; Jacobson, Judith S. / Regional and racial disparities in breast cancer-specific mortality. In: Social Science and Medicine. 2006 ; Vol. 62, No. 2. pp. 337-347.
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