Abstract B077: Understanding the relationship between neighborhood deprivation and breast cancer mortality among Black and White women
Authors: Barber Lauren E. , Moubadder Leah , Maliniak Maret L. , Miller-Kleinhenz Jasmine M. , Switchenko Jeffrey M. , McCullough Lauren E. 
Published: December 2023

Abstract
Background: Neighborhood deprivation has been associated with increased breast cancer mortality among White women, but findings are inconsistent among Black women, who are more likely to die from the disease. To improve our understanding of the relation, we investigated the joint effects of race and neighborhood racial composition, residential mobility, and rurality on the neighborhood deprivation-breast cancer mortality association among White and Black women. Methods: In 2010-2017, 31,358 non-Hispanic White and Black women diagnosed with invasive stage I-IIIA breast cancer were identified by the Georgia Cancer Registry and were followed through 2019 for breast cancer mortality. The neighborhood deprivation index (NDI) was derived through principal component analysis of 2011-2015 block group-level American Community Survey (ACS) data on poverty, income, housing, unemployment, occupation, and education. Neighborhood racial composition and residential mobility were measured using 2011-2015 ACS data. Rurality was measured using Georgia Department of Public Health data. We used Cox proportional hazards regression to estimate multivariable hazard ratios (HR) and 95% confidence intervals (CI) for the association between NDI, in quintiles, and breast cancer mortality, overall and according to joint effects of race and neighborhood characteristics (neighborhood racial composition, residential mobility, and rurality). Results: During follow-up, 2,353 (1,347 non-Hispanic White, 1,006 non-Hispanic Black) women died from breast cancer. Living in the most deprived neighborhoods was associated with a 30% increased risk of breast cancer mortality (quintile 5 vs. 1: HR=1.30, 95% CI 1.13-1.49). The association was present among non-Hispanic White (quintile 5 vs. 1: HR=1.47, 95% CI 1.20-1.79) but not non-Hispanic Black women. We observed similar race-specific patterns when assessing jointly stratified associations. For example, among non-Hispanic White women, neighborhood deprivation was associated with breast cancer mortality irrespective of the additional neighborhood characteristics considered, with the strongest association observed among non-Hispanic White women living in the most deprived rural neighborhoods compared to those living in the least deprived urban neighborhoods (HR=1.70, 95% CI 1.30-2.22). In contrast, no association was found among non-Hispanic Black women in any strata of neighborhood racial composition, residential mobility, or rurality (non-Hispanic Black women living in the most deprived rural neighborhoods vs. those living in the least deprived urban neighborhoods: HR=1.05, 95% CI 0.78-1.41). Conclusions: Consistent with previous studies, our study found that living in a deprived neighborhood may increase breast cancer mortality among non-Hispanic White but not non-Hispanic Black women. Neighborhood racial composition, residential mobility, and rurality did not explain the lack of association among non-Hispanic Black women. Other factors beyond neighborhood may contribute to the high breast cancer mortality rate among this racial group.
Citation Format: Lauren E. Barber, Leah Moubadder, Maret L. Maliniak, Jasmine M. Miller-Kleinhenz, Jeffrey M. Switchenko, Lauren E. McCullough. Understanding the relationship between neighborhood deprivation and breast cancer mortality among Black and White women [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B077.