Neighborhood deprivation linked to higher breast cancer mortality in White women

There is an association between neighborhood deprivation and increased breast cancer mortality among non-Hispanic White women, according to a recent study in JAMA Network Open.¹

In the United States, breast cancer is the second leading cause of death among women, with Black women facing a 40% increased risk of breast cancer mortality vs White women. Factors influencing this disparity include varying access to quality treatment, high comorbidity rates, and poor tumor characteristics.

Data has indicated a potential link between racial differences in social determinants of health and breast cancer disparities. This includes neighborhood deprivation, which is racially patterned in the United States, as the risk of living in low socioeconomic neighborhoods is increased 4-fold among Black US individuals vs White US individuals.

The Vital Signs study reported reduced odds of receiving a mammogram among women with an increased number of health-related social needs.² The cost of health care access was the most significant barrier, with other barriers including low income, no health insurance, and lacking a usual source of health care.

Literature evaluating the impact of neighborhood deprivation on breast cancer mortality based on race remains limited.¹ Investigators conducted a cohort study to evaluate this association among Black and White US patients.

Non-Hispanic Black and non-Hispanic White women registered in the Georgia Cancer Registry receiving a breast cancer diagnosis between 2010 and 2017 were included in the analysis. Exclusion criteria included being aged under 18 years at diagnosis, having an autopsy or death certificate only diagnosis, missing data, and in situ breast cancer.

The Neighborhood Deprivation Index (NDI) was used to measure neighborhood deprivation. Indicators of the NDI include percentage of individuals with an annual income under the federal poverty level, percentage of households receiving public assistance, and percentage of individuals aged at least 25 years without a high school degree or General Educational Development credentials.

Additional NDI indicators include percentage of female-headed households with children aged under 18 years, percentage of households with annual income under $35,000, percentage of unemployed individuals, percentage of individuals with managerial or administrative jobs, and percentage of households with more than 1 person per room.

Indicators were measured at the US Census block group level, with NDI determined through principal component analysis. The NDI was then linked to participants’ address at diagnosis.

There were 36,795 participants aged a mean 60.3 years included in the analysis. Of participants, 30% were non-Hispanic Black, 70% non-Hispanic White, 51.4% with private health insurance, 54.4% with stage 1 breast cancer, and 67.7% with luminal A breast cancer.

Women in the highest NDI quintile were more often non-Hispanic Black, single, with Medicaid insurance, presenting with triple-negative breast cancer, and residing in a rural area vs those in the lowest quintile. Of breast cancer mortalities, 41.3% were from non-Hispanic Black women and 58.7% from non-Hispanic White women.

An association was found between neighborhood deprivation and breast cancer mortality. The NDI quintile 5 had a hazard ratio (HR) of 1.90 when compared to the NDI quintile 1. When adjusting for race, this HR decreased to 1.49.

Racial differences were reported in the association. While non-Hispanic White women had an association between living in the highest NDI quintile and increased breast cancer mortality, this association was not found in non-Hispanic Black women. The HRs for quintile 5 vs 1 among these populations were 1.47 and 1.12, respectively.

These results indicated an association between neighborhood deprivation and increased breast cancer mortality among non-Hispanic White women but not non-Hispanic Black women. Investigators concluded other factors may be responsible for increased breast cancer mortality in Black women and should be investigated.

Reference

1. Barber LE, Maliniak ML, Moubadder L, et al. Neighborhood deprivation and breast cancer mortality among Black and White women. JAMA Netw Open. 2024;7(6):e2416499. doi:10.1001/jamanetworkopen.2024.16499
2. Krewson C. The impact of health-related social needs on breast cancer screening. Contemporary OB/GYN. April 16, 2024. Accessed June 12, 2024. https://www.contemporaryobgyn.net/view/the-impact-of-health-related-social-needs-on-breast-cancer-screening