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Regional Variation in Disparities in Breast Cancer Specific Mortality Due to Race/Ethnicity, Socioeconomic Status, and Urbanization

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Abstract

Purpose

Disparities in breast cancer mortality due to race/ethnicity, area socioeconomic status (SES), and urbanization have been documented. This study examined if disparities in the risk of breast cancer specific mortality due to race/ethnicity, SES, and urbanization varied within diverse regions of California.

Methods

We identified 163,569 cases of first primary female invasive breast cancer from the California Cancer Registry diagnosed between January, 2000 and December, 2013. Cox regression was used to compute hazard ratios (HR) and 95 % confidence intervals for race/ethnicity, SES, and urbanization within eight regions of California.

Results

Blacks had an increased risk of mortality in the San Francisco Bay Area (SFBA) (HR = 1.37; 1.22–1.55), Desert Sierra (HR = 1.27; 1.08–1.49), San Diego/Orange (HR = 1.43; 1.19–1.71), and Los Angeles (LA) (HR = 1.31; 1.20–1.44). Japanese (HR = 0.62; 0.47–0.81), Chinese (HR = 0.71; 0.58–0.87), and Filipino (HR = 0.81; 0.69–0.95) women had a decreased risk of mortality in LA. Southeast Asians had a decreased risk in San Diego/Orange (HR = 0.72; 0.57–0.90) and in the SFBA (HR = 0.81; 0.67–0.98). Hispanics had a decreased risk (HR = 0.73; 0.57–0.93) and American Indians had an increased risk (HR = 2.32; 1.08–4.98) in the Tri-County region. SES was a significant risk factor for mortality in all regions except the North and Tri-County. Urbanization was a statistically significant factor for mortality only in LA (HR = 1.32; 1.08–1.60).

Conclusions

Disparities in breast cancer mortality, due to race/ethnicity, SES, and urbanization vary by region which suggests that further research is warranted concerning the role of geographic regions and neighborhoods in cancer outcomes.

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References

  1. Laden F, Spiegelman D, Neas LM, Colditz GA, Hankinson SE, Manson JE, Byrne C, Rosner BA, Speizer FE, Hunter DJ. Geographic variation in breast cancer incidence rates in a cohort of US women. J Natl Cancer Inst. 1997;89(18):1373–8.

    Article  CAS  PubMed  Google Scholar 

  2. Bray F, McCarron P, Parkin DM. The changing global patterns of female breast cancer incidence and mortality. Breast Cancer Res. 2004;6(6):229–39. doi:10.1186/bcr932.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Sturgeon SR, Schairer C, Grauman D, El Ghormli L, Devesa S. Trends in breast cancer mortality rates by region of the United States, 1950–1999. Cancer Causes Control. 2004;15(10):987–95.

    Article  PubMed  Google Scholar 

  4. Tian N, Goovaerts P, Zhan FB, Wilson JG. Identification of racial disparities in breast cancer mortality: does scale matter? Intl J Health Geogr. 2010;9:35. doi:10.1186/1476-072X-9-35.

  5. Chien LC, Yu HL, Schootman M. Efficient mapping and geographic disparities in breast cancer mortality at the county-level by race and age in the US. Spat Spatiotemporal Epidemiol. 2013;5:27–37. doi:10.1016/j.sste.2013.03.002.

  6. Bradley CJ, Given CW, Roberts C. Race, socioeconomic status, and breast cancer treatment and survival. J Natl Cancer Inst. 2002;94(7):490–6.

    Article  PubMed  Google Scholar 

  7. O'Malley CD, Le GM, Glaser SL, Shema SJ, West DW. Socioeconomic status and breast carcinoma survival in four racial/ethnic groups: a population-based study. Cancer. 2003;97(5):1303–11.

    Article  PubMed  Google Scholar 

  8. Ries L, Eisner M, Kosary M. SEER Cancer Statistics Review, 1975-2000. Bethesda, MD: National Cancer Institute; 2003.

    Google Scholar 

  9. Newman LA, Griffith KA, Jatoi I, Simon MS, Crowe JP, Colditz GA. Meta-analysis of survival in African American and white American patients with breast cancer: ethnicity compared with socioeconomic status. J Clin Oncol. 2006;24(9):1342–9.

    Article  PubMed  Google Scholar 

  10. Singh GK, Williams SD, Siahpush M, Mulhollen A. Socioeconomic, rural-urban, and racial inequalities in US Cancer Mortality: Part I—All cancers and lung cancer and Part II—Colorectal, prostate, breast, and cervical cancers. J Cancer Epidemiol. 2011:107497. doi:10.1155/2011/107497.

  11. Sprague BL, Trentham-Dietz A, Gangnon RE, Ramchandani R, Hampton JM, Robert SA, Remington PL, Newcomb PA. Socioeconomic status and survival after an invasive breast cancer diagnosis. Cancer. 2011;117(7):1542–51.

    Article  PubMed  Google Scholar 

  12. Arrington AK, Kruper L, Vito C, Yim J, Kim J, Chen SL. Rural and urban disparities in the evolution of sentinel lymph node utilization in breast cancer. Am J Surg. 2013;206(5):674–81. doi:10.1016/j.amjsurg.2013.07.007.

    Article  PubMed  Google Scholar 

  13. Boukovalas S, Sariego J. The Urban/Rural Dichotomy in the Distribution of Breast Cancer Across Pennsylvania. Am Surg. 2015;81(9):884–8.

    PubMed  Google Scholar 

  14. McNulty JA, Nail L. Cancer survivorship in rural and urban adults: a descriptive and mixed methods study. J Rural Health. 2015;31(3):282–91.

  15. Parise CA, Caggiano V. The influence of socioeconomic status on racial/ethnic disparities among the ER/PR/HER2 breast cancer subtypes. J Cancer Epidemiol. 2015;2015:813456. doi:10.1155/2015/813456.

  16. Horner-Johnson W, Dobbertin K, Iezzoni LI. Disparities in receipt of breast and cervical cancer screening for rural women age 18 to 64 with disabilities. Womens Health Issues. 2015;25(3):246–53.

  17. California QuickFacts. United States Department of Commerce, United States Census Bureau. 2014. http://quickfacts.census.gov/qfd/states/06000.html.

  18. Fritz AG. International classification of diseases for oncology : ICD-O. 3rd ed. Geneva, Geneva: World Health Organization; 2000.

    Google Scholar 

  19. Cancer reporting in California: Abstracting and coding procedures for hospitals. California cancer reporting system standards, Volume I. California Department of Public, Cancer Surveillance and Research Branch: Sacramento, CA; 2008.

  20. ICD10Data.com. 2016. http://www.icd10data.com/. Accessed Jan 2016.

  21. California Cancer Registry. (2016). http://www.cancer-rates.info/ca/. Accessed 24 June 2016.

  22. About MSSA in California. California Office of Statewide Health Planning and Development. http://gis.oshpd.ca.gov/atlas/topics/mssa (2016).

  23. Bauer KR, Brown M, Creech C, Schlag NC, Caggiano V. Data quality assessment of HER2 in the Sacramento Region of the California Cancer Registry. Journal of Registry Management. 2007;34(1):4–7.

    Google Scholar 

  24. Yang J, Schupp CW, Harrati A, Clarke CA, Keegan TH, Gomez SL: Developing an area-based socioeconomic measure from American Community Survey. Cancer Prevention Institute of California, Freemont CA. (http://www.cpic.org/cancer-registry/cancer-surveillance/acs-ses-report.aspx) 2014.

  25. Yost K, Perkins C, Cohen R, Morris C, Wright W. Socioeconomic status and breast cancer incidence in California for different race/ethnic groups. Cancer Causes Control. 2001;12(8):703–11.

    Article  CAS  PubMed  Google Scholar 

  26. Clarke CA, Glaser SL, Keegan TH, Stroup A. Neighborhood socioeconomic status and Hodgkin's lymphoma incidence in California. Cancer Epidemiol Biomarkers Prev. 2005;14(6):1441–7.

    Article  PubMed  Google Scholar 

  27. Parikh-Patel A, Bates JH, Campleman S. Colorectal cancer stage at diagnosis by socioeconomic and urban/rural status in California, 1988–2000. Cancer. 2006;107(5 Suppl):1189–95.

    Article  PubMed  Google Scholar 

  28. Bauer KR, Brown M, Cress RD, Parise CA, Caggiano V. Descriptive analysis of estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and HER2-negative invasive breast cancer, the so-called triple-negative phenotype: a population-based study from the California Cancer Registry. Cancer. 2007;109(9):1721–8.

    Article  PubMed  Google Scholar 

  29. Zell JA, Rhee JM, Ziogas A, Lipkin SM, Anton-Culver H. Race, socioeconomic status, treatment, and survival time among pancreatic cancer cases in California. Cancer Epidemiol Biomarkers Prev. 2007;16(3):546–52.

    Article  PubMed  Google Scholar 

  30. Brown M, Tsodikov A, Bauer KR, Parise CA, Caggiano V. The role of human epidermal growth factor receptor 2 in the survival of women with estrogen and progesterone receptor-negative, invasive breast cancer: The California Cancer Registry, 1999–2004. Cancer. 2008;112(4):737–47.

    Article  PubMed  Google Scholar 

  31. Ou SH, Zell JA, Ziogas A, Anton-Culver H. Low socioeconomic status is a poor prognostic factor for survival in stage I nonsmall cell lung cancer and is independent of surgical treatment, race, and marital status. Cancer. 2008;112(9):2011–20.

    Article  PubMed  Google Scholar 

  32. Yin D, Morris C, Allen M, Cress R, Bates J, Liu L. Does socioeconomic disparity in cancer incidence vary across racial/ethnic groups? Cancer Causes Control. 2010;21(10):1721–30.

    Article  PubMed  PubMed Central  Google Scholar 

  33. IBM SPSS Statistics for Windows. IBM Corp, Armonk NY. 2012. vol 21.0.

  34. Grann V, Troxel AB, Zojwalla N, Hershman D, Glied SA, Jacobson JS. Regional and racial disparities in breast cancer-specific mortality. Soc Sci Med. 2006;62(2):337–47. doi:10.1016/j.socscimed.2005.06.038.

  35. Economic Research Service. United States Department of Agriculture. http://www.ers.usda.gov/faqs.aspx#10 (2016).

  36. Parise CA, Caggiano V (2013) Disparities in race/ethnicity and socioeconomic status: risk of mortality of breast cancer patients in the California Cancer Registry, 2000–2010. BMC Cancer 13: doi: 10.1186/1471-2407-1113-1449.

  37. Warner ET, Tamimi RM, Hughes ME, Ottesen RA, Wong YN, Edge SB, Theriault RL, Blayney DW, Niland JC, Winer EP, Weeks JC, Partridge AH. Racial and ethnic differences in breast cancer survival: mediating effect of tumor characteristics and sociodemographic and treatment factors. J Clin Oncol. 2015;33(20):2254–61. doi:10.1200/JCO.2014.57.1349.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Akinyemiju TF, Genkinger JM, Farhat M, Wilson A, Gary-Webb TL, Tehranifar P. Residential environment and breast cancer incidence and mortality: a systematic review and meta-analysis. BMC Cancer. 2015;15:191. doi:10.1186/s12885-015-1098-z.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Schorr V, Crabtree DA, Wagner D, Wetterau P. Difference in rural and urban mortality: implications for health education and promotion. J. Rural Health. 1989;5(1):67–80.

  40. Shugarman LR, Sorbero ME, Tian H, Jain AK, Ashwood JS. An exploration of urban and rural differences in lung cancer survival among medicare beneficiaries. Am J Public Health. 2008;98(7):1280–7. doi:10.2105/AJPH.2006.099416.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Cheng I, Shariff-Marco S, Koo J, Monroe KR, Yang J, John EM, Kurian AW, Kwan ML, Henderson BE, Bernstein L, Lu Y, Sposto R, Vigen C, Wu AH, Gomez SL, Keegan TH. Contribution of the neighborhood environment and obesity to breast cancer survival: the California Breast Cancer Survivorship Consortium. Cancer Epidemiol Biomarkers Prev. 2015;24(8):1282–90. doi:10.1158/1055-9965.EPI-15-0055.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Gomez SL, Shariff-Marco S, DeRouen M, Keegan TH, Yen IH, Mujahid M, Satariano WA, Glaser SL. The impact of neighborhood social and built environment factors across the cancer continuum: current research, methodological considerations, and future directions. Cancer. 2015;121(14):2314–30. doi:10.1002/cncr.29345.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Beyer KM, Malecki KM, Hoormann KA, Szabo A, Nattinger AB. Perceived Neighborhood Quality and Cancer Screening Behavior: Evidence from the Survey of the Health of Wisconsin. J Community Health. 2016;41(1):134–7. doi:10.1007/s10900-015-0078-1.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Pruitt SL, Lee SJ, Tiro JA, Xuan L, Ruiz JM, Inrig S. Residential racial segregation and mortality among black, white, and Hispanic urban breast cancer patients in Texas, 1995 to 2009. Cancer. 2015;121(11):1845–55. doi:10.1002/cncr.29282.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Franco M, Diez-Roux AV, Nettleton JA, Lazo M, Brancati F, Caballero B, Glass T, Moore LV. Availability of healthy foods and dietary patterns: the Multi-Ethnic Study of Atherosclerosis. Am. J. Clin. Nutr. 2009;89(3):897–904. doi:10.3945/ajcn.2008.26434.

  46. Ursin G, Bernstein L, Lord SJ, Karim R, Deapen D, Press MF, Daling JR, Norman SA, Liff JM, Marchbanks PA, Folger SG, Simon MS, Strom BL, Burkman RT, Weiss LK, Spirtas R. Reproductive factors and subtypes of breast cancer defined by hormone receptor and histology. Br. J. Cancer. 2005;93(3):364–71.

  47. Ma H, Bernstein L, Pike MC, Ursin G. Reproductive factors and breast cancer risk according to joint estrogen and progesterone receptor status: a meta-analysis of epidemiological studies. Breast Cancer Res. 2006;8(4):R43.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Yang XR, Chang-Claude J, Goode EL, Couch FJ, Nevanlinna H, Milne RL, et al. Associations of breast cancer risk factors with tumor subtypes: a pooled analysis from the Breast Cancer Association Consortium studies. J Natl Cancer Inst. 2011;103(3):250–63. doi:10.1093/jnci/djq526.

    Article  PubMed  Google Scholar 

  49. Jung S, Spiegelman D, Baglietto L, Bernstein L, Boggs DA, van den Brandt PA, et al. Fruit and vegetable intake and risk of breast cancer by hormone receptor status. J Natl Cancer Inst. 2013;105(3):219–36. doi:10.1093/jnci/djs635.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Link LB, Canchola AJ, Bernstein L, Clarke CA, Stram DO, Ursin G, Horn-Ross PL. Dietary patterns and breast cancer risk in the California Teachers Study cohort. Am. J. Clin. Nutr. 2013;98(6):1524–32. doi:10.3945/ajcn.113.061184.

  51. Warner ET, Tamimi RM, Boggs DA, Rosner B, Rosenberg L, Colditz GA, Palmer JR. Estrogen receptor positive tumors: do reproductive factors explain differences in incidence between black and white women? Cancer Causes Control. 2013;24(4):731–9. doi:10.1007/s10552-013-0153-9.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Palmer JR, Viscidi E, Troester MA, Hong CC, Schedin P, Bethea TN, Bandera EV, Borges V, McKinnon C, Haiman CA, Lunetta K, Kolonel LN, Rosenberg L, Olshan AF, Ambrosone CB. Parity, lactation, and breast cancer subtypes in African American women: results from the AMBER Consortium. J Natl Cancer Inst. 2014;106(10). doi:10.1093/jnci/dju237.

  53. Phipps AI, Li CI. Breastfeeding and triple-negative breast cancer: potential implications for racial/ethnic disparities. J Natl Cancer Inst. 2014;106(10). doi:10.1093/jnci/dju281.

  54. Sieri S, Chiodini P, Agnoli C, Pala V, Berrino F, Trichopoulou A, et al. Dietary fat intake and development of specific breast cancer subtypes. J Natl Cancer Inst. 2014;106(5). doi:10.1093/jnci/dju068.

  55. Gomez SL, Clarke CA, Shema SJ, Chang ET, Keegan TH, Glaser SL. Disparities in breast cancer survival among Asian women by ethnicity and immigrant status: a population-based study. Am J Public Health. 2010;100(5):861–9. doi:10.2105/AJPH.2009.176651.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

We wish to thank Theresa Johnson, Sharon Babcock, and Samuel Fry at the Sutter Resource Library for their valuable assistance.

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Authors and Affiliations

  1. Sutter Institute for Medical Research, 2801 Capitol Ave Suite 400, Sacramento, California, 95816, USA

    Carol A. Parise & Vincent Caggiano

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  1. Carol A. Parise
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  2. Vincent Caggiano
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Correspondence to Carol A. Parise.

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Neither author has any disclosures to report.

Human Subjects Protection

This research study involved analysis of existing data from the CCR without subject identifiers or intervention. Therefore, the study was categorized as exempt from institutional review board oversight.

Funding

This study was funded by grant 947110-1107555 from the Sutter Medical Center Sacramento Foundation.

Disclaimer

The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract N01-PC-35136 awarded to the Northern California Cancer Center, contract N01-PC-35139 awarded to the University of Southern California, and contract N01-PC-54404 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement 1U58DP00807-01 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the authors and endorsement by the State of California, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred.

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Parise, C.A., Caggiano, V. Regional Variation in Disparities in Breast Cancer Specific Mortality Due to Race/Ethnicity, Socioeconomic Status, and Urbanization . J. Racial and Ethnic Health Disparities 4, 706–717 (2017). https://doi.org/10.1007/s40615-016-0274-4

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