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The Effect of Patient and Contextual Characteristics on Racial/Ethnic Disparity in Breast Cancer Mortality.

  • Author(s): Sposto, Richard
  • Keegan, Theresa HM
  • Vigen, Cheryl
  • Kwan, Marilyn L
  • Bernstein, Leslie
  • John, Esther M
  • Cheng, Iona
  • Yang, Juan
  • Koo, Jocelyn
  • Kurian, Allison W
  • Caan, Bette J
  • Lu, Yani
  • Monroe, Kristine R
  • Shariff-Marco, Salma
  • Gomez, Scarlett Lin
  • Wu, Anna H
  • et al.

Published Web Location

http://cebp.aacrjournals.org/content/25/7/1064.long
No data is associated with this publication.
Abstract

BACKGROUND:Racial/ethnic disparity in breast cancer-specific mortality in the United States is well documented. We examined whether accounting for racial/ethnic differences in the prevalence of clinical, patient, and lifestyle and contextual factors that are associated with breast cancer-specific mortality can explain this disparity. METHODS:The California Breast Cancer Survivorship Consortium combined interview data from six California-based breast cancer studies with cancer registry data to create a large, racially diverse cohort of women with primary invasive breast cancer. We examined the contribution of variables in a previously reported Cox regression baseline model plus additional contextual, physical activity, body size, and comorbidity variables to the racial/ethnic disparity in breast cancer-specific mortality. RESULTS:The cohort comprised 12,098 women. Fifty-four percent were non-Latina Whites, 17% African Americans, 17% Latinas, and 12% Asian Americans. In a model adjusting only for age and study, breast cancer-specific HRs relative to Whites were 1.69 (95% CI, 1.46-1.96), 1.00 (0.84-1.19), and 0.52 (0.33-0.85) for African Americans, Latinas, and Asian Americans, respectively. Adjusting for baseline-model variables decreased disparity primarily by reducing the HR for African Americans to 1.13 (0.96-1.33). The most influential variables were related to disease characteristics, neighborhood socioeconomic status, and smoking status at diagnosis. Other variables had negligible impact on disparity. CONCLUSIONS:Although contextual, physical activity, body size, and comorbidity variables may influence breast cancer-specific mortality, they do not explain racial/ethnic mortality disparity. IMPACT:Other factors besides those investigated here may explain the existing racial/ethnic disparity in mortality. Cancer Epidemiol Biomarkers Prev; 25(7); 1064-72. ©2016 AACR.

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