Dataset Information

Racial/Ethnic Differences in the Impact of Neighborhood Social and Built Environment on Breast Cancer Risk: The Neighborhoods and Breast Cancer Study.

ABSTRACT: Background: Neighborhood socioeconomic status (nSES) has been found to be associated with breast cancer risk. It remains unclear whether this association applies across racial/ethnic groups independent of individual-level factors and is attributable to other neighborhood characteristics.Methods: We examined the independent and joint associations of education and nSES with odds of breast cancer. Residential addresses were geocoded for 2,838 cases and 3,117 controls and linked to nSES and social and built environment characteristics. We estimated ORs and 95% confidence intervals (CI) using multilevel logistic regression controlling for individual-level breast cancer risk factors and assessed the extent to which nSES associations were due to neighborhood characteristics.Results: Women living in the highest versus lowest nSES quintile had a nearly 2-fold greater odds of breast cancer, with elevated odds (adjusted ORs, 95% CI) for non-Hispanic whites (NHWs; 2.27; 1.45-3.56), African Americans (1.74; 1.07-2.83), U.S.-born Hispanics (1.82; 1.19-2.79), and foreign-born Hispanics (1.83; 1.06-3.17). Considering education and nSES jointly, ORs were increased for low education/high nSES NHWs (1.83; 1.14-2.95), high education/high nSES NHWs (1.64; 1.06-2.54), and high education/high nSES foreign-born Hispanics (2.17; 1.52-3.09) relative to their race/ethnicity/nativity-specific low education/low nSES counterparts. Adjustment for urban and mixed-land use characteristics attenuated the nSES associations for most racial/ethnic/nativity groups except NHWs.Conclusions: Our study provides empirical evidence for a role of neighborhood environments in breast cancer risk, specifically social and built environment attributes.Impact: Considering the role of neighborhood characteristics among diverse populations may offer insights to understand racial/ethnic disparities in breast cancer risk. Cancer Epidemiol Biomarkers Prev; 26(4); 541-52. ©2017 AACR.

SUBMITTER: Conroy SM

PROVIDER: S-EPMC5380527 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

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Publications

Racial/Ethnic Differences in the Impact of Neighborhood Social and Built Environment on Breast Cancer Risk: The Neighborhoods and Breast Cancer Study.

Conroy Shannon M SM Shariff-Marco Salma S Koo Jocelyn J Yang Juan J Keegan Theresa H M TH Sangaramoorthy Meera M Hertz Andrew A Nelson David O DO Cockburn Myles M Satariano William A WA Yen Irene H IH Ponce Ninez A NA John Esther M EM Gomez Scarlett Lin SL

Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 20170214 4

<b>Background:</b> Neighborhood socioeconomic status (nSES) has been found to be associated with breast cancer risk. It remains unclear whether this association applies across racial/ethnic groups independent of individual-level factors and is attributable to other neighborhood characteristics.<b>Methods:</b> We examined the independent and joint associations of education and nSES with odds of breast cancer. Residential addresses were geocoded for 2,838 cases and 3,117 controls and linked to nSE ...[more]

PMID: 28196846

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Project description:ImportanceRacist policies (such as redlining) create inequities in the built environment, producing racially and ethnically segregated communities, poor housing conditions, unwalkable neighborhoods, and general disadvantage. Studies on built environment disparities are usually limited to measures and data that are available from existing sources or can be manually collected.ObjectiveTo use built environment indicators generated from online street-level images to investigate the association among neighborhood racial and ethnic composition, the built environment, and health outcomes across urban areas in the US.Design, setting, and participantsThis cross-sectional study was conducted using built environment indicators derived from 164 million Google Street View images collected from November 1 to 30, 2019. Race, ethnicity, and socioeconomic data were obtained from the 2019 American Community Survey (ACS) 5-year estimates; health outcomes were obtained from the Centers for Disease Control and Prevention 2020 Population Level Analysis and Community Estimates (PLACES) data set. Multilevel modeling and mediation analysis were applied. A total of 59 231 urban census tracts in the US were included. The online images and the ACS data included all census tracts. The PLACES data comprised survey respondents 18 years or older. Data were analyzed from May 23 to November 16, 2022.Main outcomes and measuresModel-estimated association between image-derived built environment indicators and census tract (neighborhood) racial and ethnic composition, and the association of the built environment with neighborhood racial composition and health.ResultsThe racial and ethnic composition in the 59 231 urban census tracts was 1 160 595 (0.4%) American Indian and Alaska Native, 53 321 345 (19.5%) Hispanic, 462 259 (0.2%) Native Hawaiian and other Pacific Islander, 17 166 370 (6.3%) non-Hispanic Asian, 35 985 480 (13.2%) non-Hispanic Black, and 158 043 260 (57.7%) non-Hispanic White residents. Compared with other neighborhoods, predominantly White neighborhoods had fewer dilapidated buildings and more green space indicators, usually associated with good health, and fewer crosswalks (eg, neighborhoods with predominantly minoritized racial or ethnic groups other than Black residents had 6% more dilapidated buildings than neighborhoods with predominantly White residents). Moreover, the built environment indicators partially mediated the association between neighborhood racial and ethnic composition and health outcomes, including diabetes, asthma, and sleeping problems. The most significant mediator was non-single family homes (a measure associated with homeownership), which mediated the association between neighborhoods with predominantly minority racial or ethnic groups other than Black residents and sleeping problems by 12.8% and the association between unclassified neighborhoods and asthma by 24.2%.Conclusions and relevanceThe findings in this cross-sectional study suggest that large geographically representative data sets, if used appropriately, may provide novel insights on racial and ethnic health inequities. Quantifying the impact of structural racism on social determinants of health is one step toward developing policies and interventions to create equitable built environment resources.

Project description:ImportanceRacial differences in breast cancer treatment may result in part from differences in the surgeons and hospitals from whom patients receive their care. However, little is known about differences in patients' selection of surgeons and hospitals.ObjectiveTo examine racial/ethnic differences in how women selected their surgeons and hospitals for breast cancer surgery.Design, setting, and participantsWe surveyed 500 women (222 non-Hispanic white, 142 non-Hispanic black, 89 English-speaking Hispanic, and 47 Spanish-speaking Hispanic) from northern California cancer registries with stage 0 to III breast cancer diagnosed during 2010 through 2011. We used multivariable logistic regression to assess the reasons for surgeon and hospital selection by race/ethnicity, adjusting for other patient characteristics. We also assessed the association between reasons for physician selection and patients' ratings of their surgeon and hospital.Main outcomes and measuresReasons for surgeon and hospital selection and ratings of surgeon and hospital.ResultsThe 500 participants represented a response rate of 47.8% and a participation rate of 69%. The most frequently reported reason for surgeon selection was referral by another physician (78%); the most frequently reported reason for hospital selection was because it was a part of a patient's health plan (58%). After adjustment, 79% to 87% of black and Spanish-speaking Hispanic women reported selecting their surgeon based on a physician's referral vs 76% of white women (P = .007). Black and Hispanic patients were less likely than white patients to report selecting their surgeon based on reputation (adjusted rates, 18% and 22% of black and Hispanic women, respectively, vs 32% of white women; P = .02). Black and Hispanic women were also less likely than white women to select their hospital based on reputation (adjusted rates, 7% and 15% vs 23%, respectively; P = .003). Women who selected their surgeon based on reputation more often rated the care from their surgeon as excellent (adjusted odds ratio, 2.21; 95% CI, 1.24-3.93); those reporting their surgeon was one of the only surgeons available through the health plan less often reported excellent quality of surgical care (adjusted odds ratio, 0.56; 95% CI, 0.34-0.91).Conclusions and relevanceCompared with white patients with breast cancer, minority patients were less actively involved in physician and hospital selection, relying more on physician referral and health plans rather than on reputation. Interventions to promote involvement in surgeon and hospital selection may have potential for addressing disparities related to lower-quality care from surgeons and hospitals.

Dataset Information

Racial/Ethnic Differences in the Impact of Neighborhood Social and Built Environment on Breast Cancer Risk: The Neighborhoods and Breast Cancer Study.

Publications

Racial/Ethnic Differences in the Impact of Neighborhood Social and Built Environment on Breast Cancer Risk: The Neighborhoods and Breast Cancer Study.

Similar Datasets

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