Socioeconomic status and breast cancer incidence in California for different race/ethnic groups
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.
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- 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.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.Liu L, Deapen D, Bernstein L (1988) Socioeconomic status and cancer of females. Cancer Causes Control 9: 369–380.Google Scholar
- 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.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.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.Liberatos P, Link B, Kelsey J (1988) The measurement of social class in epidemiology. Epidemiol Rev 10: 87–121.Google Scholar
- 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.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.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.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.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.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.Bollen K, Lennox R (1991) Conventional wisdom on measurement: a structural equation prospective. Psychol Bull 110: 305–314.Google Scholar
- 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.SAS Institute Inc. (1989) SAS/STAT User's Guide, Version 6, 4th edn. Cary, NC: SAS Institute, Inc.Google Scholar
- 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.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.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.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.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.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.Dobson AJ (1990) An Introduction to Generalized Linear Models, 1st edn. London: Chapman & Hall.Google Scholar
- 24.Greenland S (1989) Modeling and variable selection in epidemiologic analysis. Am J Public Health 79: 340–349.Google Scholar
- 25.Kelsey J, Horn-Ross P (1993) Breast cancer: magnitude of the problem and descriptive epidemiology. Epidemiol Rev 15: 7–16.Google Scholar
- 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.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