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- Title
Neighborhood Disadvantage and Breast Cancer–Specific Survival.
- Authors
Goel, Neha; Hernandez, Alexandra; Thompson, Cheyenne; Choi, Seraphina; Westrick, Ashly; Stoler, Justin; Antoni, Michael H.; Rojas, Kristin; Kesmodel, Susan; Figueroa, Maria E.; Cole, Steve; Merchant, Nipun; Kobetz, Erin
- Abstract
Key Points: Question: Is living in a disadvantaged neighborhood associated with breast cancer–specific survival in a majority-minority population? Findings: In this cohort study of 5027 patients with breast cancer, neighborhood disadvantage was associated with shorter breast cancer–specific survival. This finding was noted after adjusting for individual-level sociodemographic, comorbidity, breast cancer risk factor, access to care, tumor, and National Comprehensive Cancer Network guideline-concordant treatment characteristics. Meaning: The findings of this study suggest unaccounted mechanisms associated with breast cancer–specific survival, such as unmeasured social and access to care barriers, and lays the foundation for future research evaluating whether neighborhood disadvantage leads to more aggressive tumor biologic factors through the accumulation of social and environmental stressors. Importance: Neighborhood-level disadvantage is an important factor in the creation and persistence of underresourced neighborhoods with an undue burden of disparate breast cancer–specific survival outcomes. Although studies have evaluated neighborhood-level disadvantage and breast cancer–specific survival after accounting for individual-level socioeconomic status (SES) in large national cancer databases, these studies are limited by age, socioeconomic, and racial and ethnic diversity. Objective: To investigate neighborhood SES (using a validated comprehensive composite measure) and breast cancer–specific survival in a majority-minority population. Design, Setting, and Participants: This retrospective multi-institutional cohort study included patients with stage I to IV breast cancer treated at a National Cancer Institute–designated cancer center and sister safety-net hospital from January 10, 2007, to September 9, 2016. Mean (SD) follow-up time was 60.3 (41.4) months. Data analysis was performed from March 2022 to March 2023. Exposures: Neighborhood SES was measured using the Area Deprivation Index (tertiles), a validated comprehensive composite measure of neighborhood SES. Main Outcomes and Measures: The primary outcome was breast cancer–specific survival. Random effects frailty models for breast cancer–specific survival were performed controlling for individual-level sociodemographic, comorbidity, breast cancer risk factor, access to care, tumor, and National Comprehensive Cancer Network guideline-concordant treatment characteristics. The Area Deprivation Index was calculated for each patient at the census block group level and categorized into tertiles (T1-T3). Results: A total of 5027 women with breast cancer were included: 55.8% were Hispanic, 17.5% were non-Hispanic Black, and 27.0% were non-Hispanic White. Mean (SD) age was 55.5 (11.7) years. Women living in the most disadvantaged neighborhoods (T3) had shorter breast cancer–specific survival compared with those living in the most advantaged neighborhoods (T1) after controlling for individual-level sociodemographic, comorbidity, breast cancer risk factor, access to care, tumor, and National Comprehensive Cancer Network guideline-concordant treatment characteristics (T3 vs T1: hazard ratio, 1.29; 95% CI, 1.01-1.65; P <.04). Conclusions and Relevance: In this cohort study, a shorter breast cancer–specific survival in women from disadvantaged neighborhoods compared with advantaged neighborhoods was identified, even after controlling for individual-level sociodemographic, comorbidity, breast cancer risk factor, access to care, tumor, and National Comprehensive Cancer Network guideline-concordant treatment characteristics. The findings suggest potential unaccounted mechanisms, including unmeasured social determinants of health and access to care measures. This study also lays the foundation for future research to evaluate whether social adversity from living in a disadvantaged neighborhood is associated with more aggressive tumor biologic factors, and ultimately shorter breast cancer-specific survival, through social genomic and/or epigenomic alterations. This cohort study examines the association of neighborhood-level disadvantage with breast cancer–specific survival in a racially and ethnically diverse population.
- Subjects
FLORIDA; BREAST cancer prognosis; BREAST tumor risk factors; RESEARCH; STATISTICS; HEALTH services accessibility; CONFIDENCE intervals; SOCIAL determinants of health; ANALYSIS of variance; AGE distribution; RETROSPECTIVE studies; ACQUISITION of data; RACE; SOCIOECONOMIC factors; TUMOR classification; RISK assessment; COMPARATIVE studies; HEALTH service areas; T-test (Statistics); MEDICAL records; DESCRIPTIVE statistics; KAPLAN-Meier estimator; RESEARCH funding; SURVIVAL analysis (Biometry); CHI-squared test; HEALTH equity; SOCIODEMOGRAPHIC factors; BODY mass index; DATA analysis software; NEIGHBORHOOD characteristics; LONGITUDINAL method; PROPORTIONAL hazards models
- Publication
JAMA Network Open, 2023, Vol 6, Issue 4, pe238908
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.8908