Abstract B040: The impact of racial/ethnic discrimination and residential segregation on cancer survivorship
Authors: Shariff-Marco Salma , Ellis Elizabeth , Sangaramoorthy Meera , Jain Jennfier , Thomsen Catherine , Ambrosone Christine , Kushi Lawrence , Kroenke Candyce , Gomez Scarlett L. 
Published: August 2020

Background: Racial/ethnic disparities in access to care, receipt of treatment, and cancer outcomes are well documented. Racial/ethnic discrimination has been proposed as an important explanatory factor, with interpersonal and institutional discrimination shown to be associated with adverse outcomes. However, the impact of racial/ethnic discrimination on cancer survivorship outcomes is unclear. Thus, we proposed to: (1) assess self-reported experiences of racial/ethnic discrimination in the Pathways Study and (2) examine associations with self-reported racial/ethnic discrimination and quality of life (QoL), and whether these associations are moderated by residential segregation.

Methods: The Pathways Study is a prospective cohort of 4,505 women with incident breast cancer in the Kaiser Permanente Northern California (KPNC) integrated health care system, recruited between 2006 and 2013. Data collection included interviewer- and self-administered questionnaires with items on demographics, reproductive and family histories, lifestyle and other factors (e.g., discrimination, QoL), and updated vital status and clinical data from KPNC electronic data sources. Discrimination experiences were measured across a range of contexts—at school, getting a job, at work, getting housing, getting medical care, getting credit, from police/in court. Patient addresses were geocoded and neighborhood data including residential segregation were appended to get a multilevel dataset. The associations between discrimination, segregation and QoL were examined using linear and logistic regression models.

Results: Overall, 31% of the sample reported experiencing racial/ethnic discrimination; this varied across racial/ethnic groups from 82% of NH Blacks to 19% of NH Whites reporting discrimination. While a similar proportion of U.S.-born and foreign-born Hispanics reported discrimination (41% and 40%, respectively), there were much greater differences by nativity among Asian Americans, with 79% of U.S.-born and 49% of foreign-born reporting discrimination. Experiencing racial/ethnic discrimination was associated with lower QoL. This association persisted in fully adjusted models, and when examining the frequency of discrimination experiences. Further, in stratified analyses by residential segregation, an inverse association was observed among NH Blacks residing in low/moderately segregated neighborhoods; no associations were found among those in high segregation. An inverse association was also observed among foreign-born Hispanics in low enclave neighborhoods; no association was observed among those in high enclaves.

Conclusions: These findings of an association between racial/ethnic discrimination and QoL are consistent with the literature on the adverse health effects of self-reported racial/ethnic discrimination. Further research is needed to understand potential pathways through which these social factors impact survivorship outcomes.

Citation Format: Salma Shariff-Marco, Elizabeth Ellis, Meera Sangaramoorthy, Jennfier Jain, Catherine Thomsen, Christine Ambrosone, Lawrence Kushi, Candyce Kroenke, Scarlett L. Gomez. The impact of racial/ethnic discrimination and residential segregation on cancer survivorship [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B040.