Cancer Epidemiol Biomarkers Prev

BackgroundResearch is limited on the independent and joint effects of individual- and neighborhood-level socioeconomic status (SES) on breast cancer survival across different racial/ethnic groups.MethodsWe studied individual-level SES, measured by self-reported education, and a composite neighborhood SES (nSES) measure in females (1,068 non-Hispanic whites, 1,670 Hispanics, 993 African-Americans, and 674 Asian-Americans), aged 18\u201379 years and diagnosed 1995\u20132008, in the San Francisco Bay Area. We evaluated all-cause and breast cancer-specific survival using stage-stratified Cox proportional hazards models with cluster adjustment for census block groups.ResultsIn models adjusting for education and nSES, lower nSES was associated with worse all-cause survival among African-Americans (p-trend=0.03), Hispanics (p-trend=0.01) and Asian-Americans (p-trend=0.01). Education was not associated with all-cause survival. For breast cancer-specific survival, lower nSES was associated with poorer survival only among Asian-Americans (p-trend=0.01). When nSES and education were jointly considered, women with low education and low nSES had 1.4 to 2.7-times worse all-cause survival than women with high education and high nSES across all races/ethnicities. Among African-Americans and Asian-Americans, women with high education and low nSES had 1.6 to 1.9-times worse survival, respectively. For breast cancer-specific survival, joint associations were found only among Asian-Americans with worse survival for those with low nSES regardless of education.ConclusionsBoth neighborhood and individual SES are associated with survival after breast cancer diagnosis, but these relationships vary by race/ethnicity.ImpactA better understanding of the relative contributions and interactions of SES with other factors will inform targeted interventions towards reducing long-standing disparities in breast cancer survival.20142015-05-01T00:00:00ZHHSN261201000034C/PHS HHS/United StatesHHSN261201000035C/PHS HHS/United StatesHHSN261201000140C/PHS HHS/United StatesP30 ES007048/ES/NIEHS NIH HHS/United StatesR01 CA140058/CA/NCI NIH HHS/United StatesR01 CA63446/CA/NCI NIH HHS/United StatesR01 CA77305/CA/NCI NIH HHS/United StatesR01CA140058/CA/NCI NIH HHS/United StatesR21 CA133255/CA/NCI NIH HHS/United StatesR21CA133255/CA/NCI NIH HHS/United StatesU58DP003862-01/DP/NCCDPHP CDC HHS/United StatesUM1 CA164920/CA/NCI NIH HHS/United States24618999PMC40182391075