Neighborhood disadvantage tied to higher breast cancer mortality in black women

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A new study finds that Black women living in economically disadvantaged neighborhoods face significantly higher breast cancer mortality rates.

Neighborhood disadvantage tied to higher breast cancer mortality in black women | Image Credit: © Konstantin L - © Konstantin L - stock.adobe.com.

Neighborhood disadvantage tied to higher breast cancer mortality in black women | Image Credit: © Konstantin L - © Konstantin L - stock.adobe.com.

Increased mortality risk linked to neighborhood disadvantage

The odds of breast cancer mortality among Black women are increased by residing in a disadvantaged neighborhood, according to a recent study published in JAMA Network Open.1

Black women face a 41% increased risk of breast cancer mortality compared to their White counterparts.2 Experts have hypothesized neighborhood disadvantage as a factor contributing to this disparity, as Black US residents are more likely to reside in disadvantaged neighborhoods regardless of socioeconomic (SES) status.1

“Previous studies have generally found associations of indices of neighborhood SES with breast cancer mortality, but most research has been conducted within a specific state and results specific to Black women have been inconsistent,” wrote investigators.

Study design and participant overview

To evaluate the impact of neighborhood disadvantage on breast cancer mortality, investigators conducted a prospective cohort study. Participants included Black women aged 21 to 69 years completing a questionnaire distributed to Essence magazine subscribers.

Self-reported breast cancer cases were linked with 29 state cancer registries and the National Death index, with a first invasive breast cancer diagnosed among 3213 participants between 1997 and 2019. Exclusion criteria included stage 4 breast cancer at diagnosis and mortality within 12 months of diagnosis.

Hospital pathology reports and state cancer registry data were assessed for data on tumor characteristics. This included treatment data, which was also collected through self-report.

Neighborhood index scoring criteria

Indices assessed included the neighborhood concentrated disadvantage (nDIS), neighborhood SES (nSES), and the Index of Concentration at the Extremes (ICE). Neighborhood level indices were assessed based on the most recent address following breast cancer diagnosis.

ICE scores ranged from 1 to -1, with lower scores indicating greater economic disadvantage. Six variables were used to calculate the nDIS score: the rate of individuals below the povery line, receiving public assistance, living in female-headed households, unemployed, aged under 18 years, and Black.

For the nSES score, the 6 variables used were median household income, median household value, percentage of households receiving interest, adults aged at least 25 years with college education, patients aged 16 years or older, and 2-parent households. Patients with higher nSES scores lived in more affluent neighborhoods.

Covariates and patient demographics

Experiences with racism were self-reported in the 1997, 2009, and 2019 questionnaires. Covariates included age at diagnosis, stage at diagnosis, estrogen receptor (ER) status, tumor grade, educational attainment, body mass index, menopausal status, type 2 diabetes, region of residence, alcohol consumption, smoking status, insurance status, and vigorous activity.

There were 2290 Black women aged a mean 56.7 years at diagnosis. Of these patients, 602 died, with 305 deaths linked to breast cancer. Cancer diagnosis occurred at stage 1 in 52.6% of cases, stage 2 in 36.8%, and stage 3 in 10.6%. ER status was available in 90.3%, with 62% being ER positive and 28.3% ER negative.

Mortality risk by neighborhood disadvantage

A hazard ratio (HR) of 1.62 was reported for living in the most disadvantaged nDIS quartile vs the least disadvantaged nDIS quartile. When adjusting for stage and ER status, the HR was 1.57.

Additionally, an HR of 1.19 was reported for living in extreme economic deprivation vs economic privilege based on ICE score, but this was not statistically significant. The HR for nSES quartiles was also not statistically significant.

Individual disadvantage indicators

Percentage female-headed households, unemployed, and Black residents were the 3 nDIS variables most significantly linked to breast cancer mortality, with HRs of 1.21, 1.12, and 1.11, respectively. These association remained significant across ER status, age of diagnosis, and educational attainment.

ICE was positively correlated with breast cancer mortality among women with ER-positive breast cancer and those diagnosed at stage 2, with HRs of 1.58 and 1.51, respectively. Overall, increased breast cancer mortality was found among Black patients living in disadvantaged neighborhoods.

“The findings suggest that attributes of the neighborhood environment may contribute to poorer survival,” wrote investigators. “These attributes include chronic exposure to stressors (eg, noise, lack of green space), longer distance to treatment facilities, and limited access to a nutritional food environment.”

References

  1. Holder EX, Barnard ME, Xu NN, Barber LE, Palmer JR. Neighborhood disadvantage, individual experiences of racism, and breast cancer survival. JAMA Netw Open. 2025;8(4):e253807. doi:10.1001/jamanetworkopen.2025.3807
  2. Ellington TD, Henley SJ, Wilson RJ, Miller JW, Wu M, Richardson LC. Trends in breast cancer mortality by race/ethnicity, age, and US census region, United States—1999-2020.Cancer. 2023;129(1):32-38. doi:10.1002/cncr.34503
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