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Mapping hot spots of breast cancer mortality in the United States: place matters for Blacks and Hispanics

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Abstract

Purpose

The goals of this study were to identify geographic and racial/ethnic variation in breast cancer mortality, and evaluate whether observed geographic differences are explained by county-level characteristics.

Methods

We analyzed data on breast cancer deaths among women in 3,108 contiguous United States (US) counties from years 2000 through 2015. We applied novel geospatial methods and identified hot spot counties based on breast cancer mortality rates. We assessed differences in county-level characteristics between hot spot and other counties using Wilcoxon rank-sum test and Spearman correlation, and stratified all analysis by race/ethnicity.

Results

Among all women, 80 of 3,108 (2.57%) contiguous US counties were deemed hot spots for breast cancer mortality with the majority located in the southern region of the US (72.50%, p value < 0.001). In race/ethnicity-specific analyses, 119 (3.83%) hot spot counties were identified for NH-Black women, with the majority being located in southern states (98.32%, p value < 0.001). Among Hispanic women, there were 83 (2.67%) hot spot counties and the majority was located in the southwest region of the US (southern = 61.45%, western = 33.73%, p value < 0.001). We did not observe definitive geographic patterns in breast cancer mortality for NH-White women. Hot spot counties were more likely to have residents with lower education, lower household income, higher unemployment rates, higher uninsured population, and higher proportion indicating cost as a barrier to medical care.

Conclusions

We observed geographic and racial/ethnic disparities in breast cancer mortality: NH-Black and Hispanic breast cancer deaths were more concentrated in southern, lower SES counties.

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Funding

Funding was provided by National Cancer Institute (Grant Nos. R25 CA47888, U54 CA118948, and T32190194), Foundation for Barnes-Jewish Hospital, and National Institute for Nursing Research ( Grant No R01-NR012726).

Author information

Authors and Affiliations

  1. Departments of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA

    Justin Xavier Moore, Russell Griffin, Bertha Hidalgo & Tomi Akinyemiju

  2. Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA

    Justin Xavier Moore, Kendra J. Royston & Tomi Akinyemiju

  3. Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, St Louis, MO, USA

    Justin Xavier Moore, Marvin E. Langston & Graham Colditz

  4. Department of Biology, University of Alabama at Birmingham, Birmingham, AL, USA

    Kendra J. Royston

  5. Department of Emergency Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA

    Henry E. Wang

  6. Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    Henry E. Wang

  7. Department of Epidemiology, University of Kentucky, Lexington, KY, USA

    Tomi Akinyemiju

  8. Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S Taylor Avenue, TAB 2nd Floor Suite East, 7E, Saint Louis, MO, 63110–1093, USA

    Justin Xavier Moore

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  1. Justin Xavier Moore
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Corresponding author

Correspondence to Justin Xavier Moore.

Electronic supplementary material

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Supplementary Tables 1 and 2 (DOCX 15 KB)

Supplementary Table 3 (DOCX 176 KB)

Supplementary Table 4 (DOCX 180 KB)

Supplementary Table 5 (DOCX 175 KB)

Supplementary Table 6 (DOCX 164 KB)

Supplemental Figure 1

: Getis-Ord (Gi*) for breast cancer mortality hot spots, among all women in the contiguous United States, years 2000 – 2015. (TIF 4934 KB)

Supplemental Figure 2

: Local indicators of spatial association (LISA) for breast cancer mortality, among all women in the contiguous United States, years 2000 – 2015. (TIF 4710 KB)

Supplemental Figure 3

: Breast cancer mortality using spatial Empirical Bayes (EB) smoothed rates quintiles, among all women in the Contiguous United States, years 2000 – 2015. (TIF 5027 KB)

Supplemental Figure 4

: Getis-Ord (Gi*) for breast cancer mortality hot spots, among NH-Black women in the contiguous United States, years 2000 – 2015. (TIF 6918 KB)

Supplemental Figure 5

: Local indicators of spatial association (LISA) for breast cancer mortality, among NH-Black women in the contiguous United States, years 2000 – 2015. (TIF 6565 KB)

Supplemental Figure 6

: Breast cancer mortality using spatial Empirical Bayes (EB) smoothed rates quintiles, among NH-Black women in the Contiguous United States, years 2000 – 2015. (TIF 7139 KB)

Supplemental Figure 7

: Getis-Ord (Gi*) for breast cancer mortality hot spots, among Hispanic women in the contiguous United States, years 2000 – 2015. (TIF 5983 KB)

Supplemental Figure 8

: Local indicators of spatial association (LISA) for breast cancer mortality, among Hispanic women in the contiguous United States, years 2000 – 2015. (TIF 5618 KB)

Supplemental Figure 9

: Breast cancer mortality using spatial Empirical Bayes (EB) smoothed rates quintiles, among Hispanic women in the Contiguous United States, years 2000 – 2015. (TIF 6262 KB)

Supplemental Figure 10

: Getis-Ord (Gi*) for breast cancer mortality hot spots, among NH-White women in the contiguous United States, years 2000 – 2015. (TIF 5442 KB)

Supplemental Figure 11

: Local indicators of spatial association (LISA) for breast cancer mortality, among NH-White women in the contiguous United States, years 2000 – 2015. (TIF 5459 KB)

Supplemental Figure 12

: Breast cancer mortality using spatial Empirical Bayes (EB) smoothed rates quintiles, among NH-White women in the Contiguous United States, years 2000 – 2015. (TIF 5811 KB)

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Moore, J.X., Royston, K.J., Langston, M.E. et al. Mapping hot spots of breast cancer mortality in the United States: place matters for Blacks and Hispanics. Cancer Causes Control 29, 737–750 (2018). https://doi.org/10.1007/s10552-018-1051-y

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  • DOI: https://doi.org/10.1007/s10552-018-1051-y

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