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The Implications of Racialized Economic Segregation and Allostatic Load on Mortality in Patients with Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The objective of this study was to examine the association between racialized economic segregation, allostatic load (AL), and all-cause mortality in patients with breast cancer.

Patients and Methods

Women aged 18+ years with stage I–III breast cancer diagnosed between 01/01/2012 and 31/12/2020 were identified in the Ohio State University cancer registry. Racialized economic segregation was measured at the census tract level using the index of concentration at the extremes (ICE). AL was calculated with biomarkers from the cardiac, metabolic, immune, and renal systems. High AL was defined as AL greater than the median. Univariable and multivariable regression analyses using restricted cubic splines examined the association between racialized economic segregation, AL, and all-cause mortality.

Results

Among 4296 patients, patients residing in neighborhoods with the highest racialized economic segregation (Q1 versus Q4) were more likely to be Black (25% versus 2.1%, p < 0.001) and have triple-negative breast cancer (18.2% versus 11.6%, p < 0.001). High versus low racialized economic segregation was associated with high AL [adjusted odds ratio (aOR) 1.40, 95% confidence interval (CI) 1.21–1.61] and worse all-cause mortality [adjusted hazard ratio (aHR) 1.41, 95% CI 1.08–1.83]. In dose–response analyses, patients in lower segregated neighborhoods (relative to the 95th percentile) had lower odds of high AL, whereas patients in more segregated neighborhoods had a non-linear increase in the odds of high AL.

Discussion

Racialized economic segregation is associated with high AL and a greater risk of all-cause mortality in patients with breast cancer. Additional studies are needed to elucidate the causal pathways and mechanisms linking AL, neighborhood factors, and patient outcomes.

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Acknowledgements

This project is funded by The Ohio State University Comprehensive Cancer Center Pelotonia Grant. Samilia Obeng-Gyasi is funded by the Paul Calabresi Career Development Award (K12 CA133250), Conquer Cancer Breast Cancer Research Foundation Advanced Clinical Research Award for Diversity and Inclusion in Breast Cancer Research, The Society of University Surgeons, and The American Cancer Society (RSG-22-106-01-CSCT).

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA

    J. C. Chen MD, William E. Carson MD, Timothy M. Pawlik MD, PhD, MPH, MTS, MBA & Samilia Obeng-Gyasi MD, MPH

  2. Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA

    Demond Handley MS & Mohamed I. Elsaid PhD, MPH

  3. Secondary Data Core, Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, USA

    Demond Handley MS & Mohamed I. Elsaid PhD, MPH

  4. Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA

    Jesse J. Plascak PhD

  5. Department of Psychology, The Ohio State University, Columbus, OH, USA

    Barbara L. Andersen PhD

  6. Division of Radiology, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA

    Ruth C. Carlos MD, MS

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Correspondence to Samilia Obeng-Gyasi MD, MPH.

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Ruth Carlos: ECOG-ACRIN grant funding, paid to department; NCI grant funding, paid to department; JACR, salary support as editor-in-chief, paid to department; GERRAF and Academy of Radiology and Biomedical Imaging Research, travel reimbursement for leadership roles.

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Chen, J.C., Handley, D., Elsaid, M.I. et al. The Implications of Racialized Economic Segregation and Allostatic Load on Mortality in Patients with Breast Cancer. Ann Surg Oncol 31, 365–375 (2024). https://doi.org/10.1245/s10434-023-14431-1

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