Neighborhood deprivation tied to increased breast cancer mortality for white women

Key takeaways:

• Living in the most deprived neighborhoods was linked to increased breast cancer mortality among white, but not Black, women with breast cancer.
• The link remained regardless of residency in urban or rural areas.

Living in the most deprived neighborhoods was associated with increased breast cancer mortality among white, but not Black, women, according to a cohort study published in JAMA Network Open.

“The neighborhood environment is one social determinant that is racially patterned. In the U.S., Black individuals are four times more likely than white individuals to live in deprived, socioeconomic neighborhoods, which lack physical, economic and social resources,” Lauren E. Barber, PhD, a postdoctoral fellow in the department of epidemiology at the Rollins School of Public Health at Emory University, and colleagues wrote. “Living in deprived neighborhoods may impact health and breast cancer mortality by increasing exposure to chronic stress, reducing health care access and limiting opportunities for health behaviors. Thus, neighborhood deprivation, or low neighborhood socioeconomic status, is hypothesized as a potential contributor to the breast cancer mortality racial disparity.”

Barber and colleagues conducted a population-based cohort study using data from the Georgia Cancer Registry to identify 36,795 Black and white women (mean age, 60.3 years) diagnosed with invasive early-stage breast cancer from 2010 to 2017 and followed until 2022. Using the Neighborhood Deprivation Index, researchers evaluated whether neighborhood deprivation was associated with breast cancer mortality and whether interactions with rurality, residential mobility and racial composition changed any associations in this population.

Overall, 30% of women with breast cancer were Black. During follow-up, 2,942 women died due to breast cancer, of which 41.3% were Black and 58.7% were white women.

Living in the most deprived neighborhoods was associated with a 36% increase in breast cancer mortality among white women, but not Black women, with breast cancer (HR = 1.47; 95% CI, 1.21-1.79). This association was observed in age-adjusted models (HR = 1.9; 95% CI, 1.69-2.14) and multivariable models further adjusting for marital status and rurality (HR = 1.36; 95% CI, 1.19-1.55).

In jointly stratified analyses, researchers observed similar race-specific patterns with living in the most deprived neighborhoods that were associated with increased breast cancer mortality among white women but not Black women, regardless of residency in urban (HR = 1.39; 95% CI, 1.08-1.79) or rural (HR = 1.73; 95% CI, 1.34-2.24) counties.

“Further investigation of neighborhood residential mobility may help identify subgroups of non-Hispanic Black women at increased risk,” the researchers wrote. “However, other factors beyond those explored may contribute to increased breast cancer mortality among Black women and should be interrogated.”