Racial segregation and disparities in breast cancer care and mortality

Authors

  • Jennifer S. Haas MD, MSPH,

    Corresponding author
    1. Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
    2. Department of Medicine, Harvard Medical School, Boston, Massachusetts
    • Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA 02120–1613
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    • Fax: (617) 732–7072

  • Craig C. Earle MD,

    1. Department of Medical Oncology, Dana–Farber Cancer Institute, Boston, Massachusetts
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  • John E. Orav PhD,

    1. Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
    2. Department of Medicine, Harvard Medical School, Boston, Massachusetts
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  • Phyllis Brawarsky MPH,

    1. Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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  • Marie Keohane,

    1. Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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  • Bridget A. Neville MPH,

    1. Department of Medical Oncology, Dana–Farber Cancer Institute, Boston, Massachusetts
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  • David R. Williams PhD, MPH

    1. Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts
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Abstract

BACKGROUND.

Questions have existed as to whether residential segregation is a mediator of racial/ethnic disparities in breast cancer care and breast cancer mortality, or has a differential effect by race/ethnicity.

METHODS.

Data from the Surveillance, Epidemiology, and End Results–Medicare database on white, black, and Hispanic women aged 66 to 85 years with breast cancer were examined for the receipt of adequate breast cancer care.

RESULTS.

Blacks were less likely than whites to receive adequate breast cancer care (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.71-0.86). Individuals, both black and white, who lived in areas with greater black segregation were less likely to receive adequate breast cancer care (OR, 0.73; 95% CI, 0.64-0.82). Black segregation was a mediator of the black/white disparity in breast cancer care, explaining 8.9% of the difference. After adjustment, adequate care for Hispanics did not significantly differ from whites, but individuals, both Hispanic and white, who lived in areas with greater Hispanic segregation were less likely to receive adequate breast cancer care (OR, 0.73; 95% CI, 0.61-0.89). Although Blacks experienced greater breast cancer mortality than whites, black segregation did not substantially mediate the black-white disparity in survival, and was not significantly associated with mortality (hazards ratio, 1.03; 95% CI, 0.87-1.21). Breast cancer mortality did not differ between Hispanics and whites.

CONCLUSIONS.

Among seniors, segregation mediates some of the black-white disparity in breast cancer care, but not mortality. Individuals who live in more segregated areas are less likely to receive adequate breast cancer care. Cancer 2008. © 2008 American Cancer Society.

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