Cancer Causes & Control

, Volume 12, Issue 8, pp 703–711 | Cite as

Socioeconomic status and breast cancer incidence in California for different race/ethnic groups

  • Kathleen Yost
  • Carin Perkins
  • Richard Cohen
  • Cyllene Morris
  • William Wright


Objective: The majority of research on breast cancer risk and socioeconomic status (SES) has been conducted for blacks and whites. This study evaluates the relationship between SES and breast cancer incidence in California for four race/ethnic groups.

Methods: Principal component analysis was used to create an SES index using 1990 Census data. Untracted cases were randomly allocated to census block groups within their county of residence. A total of 97,227 female breast cancer cases diagnosed in California between 1988 and 1992 were evaluated. Incidence rates and rate ratios (RRs) were estimated and a χ2 test for trend across SES levels was performed.

Results: SES was positively related to breast cancer incidence, and this effect was stronger for Hispanics and Asian/others than for whites and blacks. Adjusting by SES did not eliminate the differences in breast cancer rates among race/ethnic groups. RR differences between the race/ethnic groups were greatest in the lowest SES category and attenuated with increasing SES. An increasing trend over SES was statistically significant for all race/ethnic groups. Including randomly allocated cases affected RR estimates for white women only.

Conclusions: Our results are consistent with similar findings for the Los Angeles area but differ from previous results for the San Francisco Bay area.

breast neoplasms censuses ethnic groups racial differences social class 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Morris C, Cohen R, Perkins C, Allen M, Schlag R, Wright W (2000) Cancer in California: 1988–1997. Sacramento, CA: California Department of Health Services, Cancer Surveillance Section.Google Scholar
  2. 2.
    Snipes KP (1996) Incidence and mortality of female breast cancer, 1988–1993. In: Morris CM, Wright WE, eds. Breast Cancer in California. Sacramento: California Department of Health Services, Cancer Surveillance Section, pp. 5–22.Google Scholar
  3. 3.
    Liu L, Deapen D, Bernstein L (1988) Socioeconomic status and cancer of females. Cancer Causes Control 9: 369–380.Google Scholar
  4. 4.
    Devesa S, Diamond E (1980) Association of breast cancer and cervical cancer incidence with income and education among whites and blacks. J Natl Cancer Inst 65: 515–528.Google Scholar
  5. 5.
    Krieger N, Quesenberry C, Jr, Peng T, et al. (1999) Social class, race/ethnicity, and incidence of breast, cervix, colon, lung, and prostate cancer among Asian, Black, Hispanic, and White residents of the San Francisco Bay Area, 1988–92 (United States). Cancer Causes Control 10: 525–537.Google Scholar
  6. 6.
    Marmot MG, Mustard JF (1994) Coronary heart disease from a population perspective. In: Evans RG, Barer ML, Marmor TR, eds. Why Are Some People Healthy and Others Not?: The Determinants of Health of Populations. New York: Aldine De Gruyter, pp. 189–214.Google Scholar
  7. 7.
    Liberatos P, Link B, Kelsey J (1988) The measurement of social class in epidemiology. Epidemiol Rev 10: 87–121.Google Scholar
  8. 8.
    Gordon N, Crowe J, Brumberg D, Berger N (1992) Socioeconomic factors and race in breast cancer recurrence and survival. Am J Epidemiol 135: 609–618.Google Scholar
  9. 9.
    Dayal HH, Power RN, Chiu C (1982) Race and socio-economic status in survival from breast cancer. J Chron Dis 35: 675–683.Google Scholar
  10. 10.
    Bassett MT, Krieger N (1986) Social class and black-white differences in breast cancer survival. Am J Public Health 76: 1400–1403.Google Scholar
  11. 11.
    Greenwald H, Polissar N, Borgatta E, McCorkle R (1994) Detecting survival effects of socioeconomic status: problems in the use of aggregate measures [See comments]. J Clin Epidemiol 47: 903–909.Google Scholar
  12. 12.
    Krieger N, Williams DR, Moss NE (1997) Measuring social class in US public health research: concepts, methodologies, and guidelines. Annu Rev Public Health 18: 341–378.Google Scholar
  13. 13.
    Eley J, Hill H, Chen V, et al. (1994) Racial differences in survival from breast cancer. Results of the National Cancer Institute Black/White Cancer Survival Study [See comments]. JAMA 272: 947–954.Google Scholar
  14. 14.
    Bollen K, Lennox R (1991) Conventional wisdom on measurement: a structural equation prospective. Psychol Bull 110: 305–314.Google Scholar
  15. 15.
    Krieger N (1992) Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health 82: 703–710.Google Scholar
  16. 16.
    SAS Institute Inc. (1989) SAS/STAT User's Guide, Version 6, 4th edn. Cary, NC: SAS Institute, Inc.Google Scholar
  17. 17.
    Kleinbaum D, Kupper L, Muller K (1988) Applied Regression Analysis and Other Multivariable Methods, 2nd edn. Boston: PWS-KENT Publishing Company.Google Scholar
  18. 18.
    Stewart SL, Swallen KC, Glaser SL, Horn-Ross PL, West DW (1998) Adjustment of cancer incidence rates for ethnic misclassification. Biometrics 54: 774–781.Google Scholar
  19. 19.
    Geronimus AT, Bound J (1998) Use of census-based aggregate variables to proxy for socioeconomic group: evidence from national samples. Am J Epidemiol 148: 475–486.Google Scholar
  20. 20.
    Geronimus A, Bound J, Neidert L (1996) On the validity of using census geocode characteristics to proxy individual socioeconomic characteristics. J Am Stat Assoc 91: 529–537.Google Scholar
  21. 21.
    Krieger N (1990) Social class and the black/white crossover in the age-specific incidence of breast cancer: a study linking census-derived data to population-based registry records. Am J Epidemiol 131: 804–814.Google Scholar
  22. 22.
    Gardner W, Mulvey EP, Shaw EC (1995) Regression analyses of counts and rates: Poisson, overdispersed Poisson, and negative binomial models. Psychol Bull 118: 392–404.Google Scholar
  23. 23.
    Dobson AJ (1990) An Introduction to Generalized Linear Models, 1st edn. London: Chapman & Hall.Google Scholar
  24. 24.
    Greenland S (1989) Modeling and variable selection in epidemiologic analysis. Am J Public Health 79: 340–349.Google Scholar
  25. 25.
    Kelsey J, Horn-Ross P (1993) Breast cancer: magnitude of the problem and descriptive epidemiology. Epidemiol Rev 15: 7–16.Google Scholar
  26. 26.
    Gilliland FD, Hunt WC, Baumgartner KB, et al. (1998) Reproductive risk factors for breast cancer in Hispanic and non-Hispanic white women: the New Mexico Women's Health Study. Am J Epidemiol 148: 683–692.Google Scholar
  27. 27.
    Stewart SL, Swallen KC, Glaser SL, Horn-Ross PL, West DW (1999) Comparison of methods for classifying Hispanic ethnicity in a population-based cancer registry. Am J Epidemiol 149: 1063–1071.Google Scholar

Copyright information

© Kluwer Academic Publishers 2001

Authors and Affiliations

  • Kathleen Yost
    • 1
  • Carin Perkins
    • 2
  • Richard Cohen
    • 1
  • Cyllene Morris
    • 1
  • William Wright
    • 2
  1. 1.Public Health InstituteSacramentoUSA
  2. 2.California Department of Health ServicesCancer Surveillance SectionSacramentoUSA

Personalised recommendations