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The association of neighborhood context with health outcomes among ethnic minority breast cancer survivors.

ABSTRACT: While individual-level determinants of health, such as education and income, have been well documented among breast cancer survivors, little is known about the role of neighborhood context on survivorship outcomes among this population. The present study examined the association of neighborhood stress with multiple health outcomes among ethnic minority breast cancer survivors (BCS). A mixed-methods approach was used to recruit 320 African-American and Hispanic BCS who were 26-89 years and lived in metropolitan Los Angeles, CA. Neighborhood stress was assessed by six items taken from the Life Stress Scale. Health outcomes included (1) self-rated health, measured by the Short-Form-36 Health Survey, (2) number of comorbidities (0-14), (3) depressive symptoms, assessed by the Center for Epidemiological Studies-Depression scale, and (4) psychological difficulties. Greater neighborhood stress was significantly associated with poorer self-reported health (adjusted ? = -.22, 95% confidence interval [CI] -.40, -.05), greater number of comorbidities (adjusted risk ratio = .19, 95% CI .07, .30), more depressive symptoms (adjusted ? = .10, 95% CI .06, .15), and a higher likelihood of psychological difficulties (adjusted odds ratio = 2.28, 95% CI 1.51, 3.45) among ethnic minority BCS. These findings underscored the importance of taking neighborhood context into account in examining the determinants of health, survivorship, and quality of life outcomes among cancer patients. Our findings may inform population health, health services, and interventions addressing neighborhood and individual-level factors to promote post treatment health and survivorship outcomes as well as to identify high-risk patients, especially among medically vulnerable communities.

SUBMITTER: Wu C

PROVIDER: S-EPMC5766377 | biostudies-other | 2018 Feb

REPOSITORIES: biostudies-other

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The association of neighborhood context with health outcomes among ethnic minority breast cancer survivors.

Wu Chenkai C Ashing Kimlin Tam KT Jones Veronica C VC Barcelo Lisa L

Journal of behavioral medicine 20170727 1

While individual-level determinants of health, such as education and income, have been well documented among breast cancer survivors, little is known about the role of neighborhood context on survivorship outcomes among this population. The present study examined the association of neighborhood stress with multiple health outcomes among ethnic minority breast cancer survivors (BCS). A mixed-methods approach was used to recruit 320 African-American and Hispanic BCS who were 26-89 years and lived ...[more]

PMID: 28752331

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Project description:BackgroundPerinatal morbidity rates are relatively high in the Netherlands, and significant inequalities in perinatal morbidity and mortality can be found across neighborhoods. In socioeconomically deprived areas, 'Western' women are particularly at risk for adverse birth outcomes. Almost all studies to date have explained the disparities in terms of individual determinants of birth outcomes. This study examines the influence of neighborhood contextual characteristics on birth weight (adjusted for gestational age) and preterm birth. We focused on the influence of neighborhood social capital--measured as informal socializing and social connections between neighbors--as well as ethnic (minority) density.MethodsData on birth weight and prematurity were obtained from the Perinatal Registration Netherlands 2000-2008 dataset, containing 97% of all pregnancies. Neighborhood-level measurements were obtained from three different sources, comprising both survey and registration data. We included 3.422 neighborhoods and 1.527.565 pregnancies for the birth weight analysis and 1.549.285 pregnancies for the premature birth analysis. Linear and logistic multilevel regression was performed to assess the associations of individual and neighborhood level variables with birth weight and preterm birth.ResultsWe found modest but significant neighborhood effects on birth weight and preterm births. The effect of ethnic (minority) density was stronger than that of neighborhood social capital. Moreover, ethnic (minority) density was associated with higher birth weight for infants of non-Western ethnic minority women compared to Western women (15 grams; 95% CI: 12,4/17,5) as well as reduced risk for prematurity (OR 0.97; CI 0,95/0,99).ConclusionsOur results indicate that neighborhood contexts are associated with birth weight and preterm birth in the Netherlands. Moreover, ethnic (minority) density seems to be a protective factor for non-Western ethnic minority women, but not for Western women. This helps explain the increased risk of Western women in deprived neighborhoods for adverse birth outcomes found in previous studies.

Project description:Recent increasing trends in breast cancer incidence and survival have resulted in unprecedented numbers of cancer survivors in the general population. A cancer diagnosis may have a profound psychological impact, and breast cancer treatments often cause long-term physical sequelae, potentially affecting women's mental health. The aim of this systematic review is to identify and summarise all studies that have compared mental health outcomes in breast cancer survivors, versus women who did not have cancer.This study will be a systematic review of the literature. Four databases, including MEDLINE and PsycINFO, will be searched to identify potentially relevant studies. The search expressions will use a Boolean logic, including terms for the target population (women who have had breast cancer), outcomes (psychiatric disorders) and comparators (e.g. risk, hazard). All mental disorders will be eligible, except those with onset normally occurring during childhood or strong genetic basis (e.g. Huntington disease). The eligibility of the studies will be assessed in two phases: (1) considering the information provided in the title and abstract; (2) evaluating the full text. Studies including women diagnosed with breast cancer 1 year or more ago and that provide original data on mental health outcomes will be eligible. Studies in which all women were undergoing surgery, chemotherapy or radiotherapy, or hospitalised or institutionalised, will be excluded, as well as studies that include patients selected on the basis of symptomatology. Two investigators will do the screening of the references and the data extraction independently, with results compared and discrepancies resolved by involving a third investigator when necessary. Study quality and risk of bias will be assessed across six broad domains. Results will be summarised by outcome, and summary measures of frequency and/or association will be computed if possible.This review will summarise the evidence on the mental health outcomes of women who have been diagnosed with breast cancer. This information can be used to motivate further research and increase understanding of the most common mental health conditions affecting this growing population of women.PROSPERO CRD42017056946.

Project description:ImportanceBlack women bear a disproportionate burden of breast cancer mortality in the US, in part due to inequities in the use of mammography. Population screening for breast cancer risk in primary care is a promising strategy for mitigating breast cancer disparities, but it is unknown whether this strategy would be associated with increased mammography rates in underserved women of racial and ethnic minority groups.ObjectiveTo examine whether providing individualized breast cancer risk estimates is associated with an increase in the rate of screening mammography.Design, setting, and participantsA cohort study was conducted in women receiving individualized risk estimates as part of routine primary health care at federally qualified health centers in medically underserved communities in Chicago, Illinois. The study was conducted from November 5, 2013, to December 19, 2014, with data acquisition completed on March 5, 2017; data analysis was performed from December 30, 2020, to February 2, 2021. A total of 347 women aged 25 to 69 years without a personal history of breast cancer presenting for an annual visit with their primary care clinician were enrolled.ExposuresBreast cancer risk estimates were obtained with validated risk assessment tools as a standard component of the clinic check-in process. One of 4 women at average risk and all women at high risk were invited to participate in the study.Main outcomes and measuresThe primary outcome was the mammography rate during 18 months of usual care compared with the rate during 18 months after implementation of risk assessment.ResultsOf the 347 women enrolled, 188 were age-eligible for mammography and were included in the analysis (mean [SD] age, 50.8 [7.04] years); 70 women (37.2%) were Hispanic, 114 (60.6%) were non-Hispanic African American, and 4 (2.1%) were from other racial and ethnic groups (4 non-Hispanic White women). Ninety-eight women (52.1%) had an average risk of developing breast cancer and 90 (47.9%) were at high risk. Overall, there was a nonsignificant increase in the mammography rate, from 38.8% during usual care to 48.9% following implementation of risk assessment (odds ratio, 1.37; 95% CI, 0.92-2.03). In preplanned subgroup analysis, the mammography rate among women at high risk was significantly higher after vs before risk assessment (51.1% vs 36.6%; odds ratio, 1.88; 95% CI, 1.10-3.23).Conclusions and relevanceIn this study, providing individualized breast cancer risk estimates as a component of primary health care in federally qualified health centers was associated with increased use of mammography among women of racial and ethnic minority groups who were at high risk. Implementation of this approach in underserved communities could promote equity in the use of mammography and reduce racial disparities in breast cancer mortality. This strategy warrants further investigation.

Dataset Information

The association of neighborhood context with health outcomes among ethnic minority breast cancer survivors.

Publications

The association of neighborhood context with health outcomes among ethnic minority breast cancer survivors.

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