In the United States, racial and economic residential segregation remains a problem. Deeply entrenched and well-documented socioeconomic, racial, and ethnic survival disparities exist, despite advances in screening, detection, diagnosis, and treatment that have decreased breast cancer mortality. In the first study of its kind, researchers at the University of Miami analyzed breast cancer survival as impacted by economic, racial, and ethnic residential segregation in South Florida using the Index of Concentration at the Extremes (ICE).
A local tumor registry was used to identify patients treated for stage I-IV breast cancer cases occurring between 2005 and 2017. As neighborhood proxies, the researchers employed census tracts.
Five ICE variables were computed using 5-year estimates from the American Community Survey:
ICE captured data on spatial socioeconomic as well as racial and ethnic segregation. For all patients included in the study, random effects frailty models were conducted and stratified based on race and ethnicity after controlling for sociodemographics, tumor characteristics, and National Comprehensive Cancer Network (NCCN) guideline-appropriate treatment.
A total of 6145 breast cancer patients were included in the study population, which comprised 52.6% Hispanic patients, 26.3% NHW patients, and 17.2% NHB patients. Patients inhabiting more economically advantaged neighborhoods were compared with those patients living in extremely impoverished neighborhoods.
Race-stratified analyses were conducted. The researchers showed that patients living in impoverished NHB neighborhoods had statistically significant increased mortality compared with those living in more economically advantaged NHW neighborhoods (hazard ratio [HR], 2.0; P <.001). After adjusting for tumor subtype and NCCN guideline–appropriate treatment, an NHW person residing in a primarily poor NHB neighborhood had increased mortality compared with an NHW person living in an economically advantaged NHW neighborhood (HR, 2.02; P <.0071).
The researchers concluded that breast cancer survival disparities are partly influenced by extreme racial, ethnic, and economic segregation. Adjustments for sociodemographics, tumor characteristics, and NCCN guideline–appropriate treatment showed that survival disparities remained, highlighting the potential social and environmental factors impacting survival. Effective interventions are required to account for the social and environmental contexts in which cancer patients live, to address these disparities.
Goel N, Kelly KN, Yadegarynia S, et al. Where you live matters: impact of economic, racial/ethnic, and racialized economic residential segregation on breast cancer survival. Presented at: 2020 San Antonio Breast Cancer Symposium, December 8-11, 2020. SS1-01.
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