RESUMO
BACKGROUND: Residential segregation is an important factor that negatively impacts cancer disparities, yet studies yield mixed results and complicate clear recommendations for policy change and public health intervention. In this study, we examined the relationship between local and Metropolitan Statistical Area (MSA) measures of Black isolation (segregation) and survival among older non-Hispanic (NH) Black women with breast cancer (BC) in the United States. We hypothesized that the influence of local isolation on mortality varies based on MSA isolation-specifically, that high local isolation may be protective in the context of highly segregated MSAs, as ethnic density may offer opportunities for social support and buffer racialized groups from the harmful influences of racism. METHODS: Local and MSA measures of isolation were linked by Census Tract (CT) with a SEER-Medicare cohort of 5,231 NH Black women aged 66-90 years with an initial diagnosis of stage I-IV BC in 2007-2013 with follow-up through 2018. Proportional and cause-specific hazards models and estimated marginal means were used to examine the relationship between local and MSA isolation and all-cause and BC-specific mortality, accounting for covariates (age, comorbidities, tumor stage, and hormone receptor status). FINDINGS: Of 2,599 NH Black women who died, 40.0% died from BC. Women experienced increased risk for all-cause mortality when living in either high local (HR = 1.20; CI = 1.08-1.33; p < 0.001) or high MSA isolation (HR = 1.40; CI = 1.17-1.67; p < 0.001). A similar trend existed for BC-specific mortality. Pairwise comparisons for all-cause mortality models showed that high local isolation was hazardous in less isolated MSAs but was not significant in more isolated MSAs. INTERPRETATION: Both local and MSA isolation are independently associated with poorer overall and BC-specific survival for older NH Black women. However, the impact of local isolation on survival appears to depend on the metropolitan area's level of segregation. Specifically, in highly segregated MSAs, living in an area with high local isolation is not significantly associated with poorer survival. While the reasons for this are not ascertained in this study, it is possible that the protective qualities of ethnic density (e.g., social support and buffering from experiences of racism) may have a greater role in more segregated MSAs, serving as a counterpart to the hazardous qualities of local isolation. More research is needed to fully understand these complex relationships. FUNDING: National Cancer Institute.
Assuntos
Neoplasias da Mama , Idoso , Feminino , Humanos , Etnicidade , Disparidades nos Níveis de Saúde , Medicare , Estados Unidos , Negro ou Afro-AmericanoRESUMO
Racial segregation has been identified as a predictor for the burden of cancer in several different metropolitan areas across the United States. This ecological study tested relationships between racial segregation and liver cancer mortality across several different metropolitan statistical areas in Wisconsin. Tract-level liver cancer mortality rates were calculated using cases from 2003-2012. Hotspot analysis was conducted and segregation scores in high, low, and baseline mortality tracts were compared using ANOVA. Spatial regression analysis was done, controlling for socioeconomic advantage and rurality. Black isolation scores were significantly higher in high-mortality tracts compared to baseline and low-mortality tracts, but stratification by metropolitan areas found this relationship was driven by two of the five metropolitan areas. Hispanic isolation was predictive for higher mortality in regression analysis, but this effect was not found across all metropolitan areas. This study showed associations between liver cancer mortality and racial segregation but also found that this relationship was not generalizable to all metropolitan areas in the study area.
Assuntos
Neoplasias Hepáticas , Segregação Social , Negro ou Afro-Americano , Humanos , Características de Residência , Fatores Socioeconômicos , Estados Unidos/epidemiologia , População Urbana , População BrancaRESUMO
PURPOSE: To calculate tract-level estimates of liver cancer mortality in Wisconsin and identify relationships with racial and socioeconomic variables. METHODS: County-level standardized mortality ratios (SMRs) of liver cancer in Wisconsin were calculated using traditional indirect adjustment methods for cases from 2003 to 2012. Tract-level SMRs were calculated using adaptive spatial filtering (ASF). The tract-level SMRs were checked for correlations to a socioeconomic advantage index (SEA) and percent racial composition. Non-spatial and spatial regression analyses with tract-level SMR as the outcome were conducted. RESULTS: County-level SMR estimates were shown to mask much of the variance within counties across their tracts. Liver cancer mortality was strongly correlated with the percent of Black residents in a census tract and moderately associated with SEA. In the multivariate spatially-adjusted regression analysis, only Percent Black composition remained significantly associated with an increased liver cancer SMR. CONCLUSIONS: Using ASF, we developed a high-resolution map of liver cancer mortality in Wisconsin. This map provided details on the distribution of liver cancer that were inaccessible in the county-level map. These tract-level estimates were associated with several racial and socioeconomic variables.
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Negro ou Afro-Americano/estatística & dados numéricos , Neoplasias Hepáticas/epidemiologia , Grupos Raciais/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Humanos , Análise de Regressão , Wisconsin/epidemiologiaRESUMO
Background: The Black-to-White disparity in breast cancer survival is increasing, and racial residential segregation is a potential driver for this trend. However, study findings have been mixed, and no study has comprehensively compared the effectiveness of different local-level segregation metrics in explaining cancer survival.Methods: We proposed a set of new local segregation metrics named local exposure and isolation (LEx/Is) and compared our new local isolation metric with two related metrics, the location quotient (LQ) and the index of concentration at extremes (ICE), across the 102 largest U.S. metropolitan areas. Then, using case data from the Milwaukee, WI, metropolitan area, we used proportional hazards models to explore associations between segregation and breast cancer survival.Results: Across the 102 metropolitan areas, the new local isolation metric was less skewed than the LQ or ICE. Across all races, Hispanic isolation was associated with poorer all-cause survival, and Hispanic LQ and Hispanic-White ICE were found to be associated with poorer survival for both breast cancer-specific and all-cause mortality. For Black patients, Black LQ was associated with lower all-cause mortality and Black local isolation was associated with reduced all-cause and breast cancer-specific mortality. ICE was found to suffer from high multicollinearity.Conclusions: Local segregation is associated with breast cancer survival, but associations varied based on patient race and metric employed.Impact: We highlight how selection of a segregation measure can alter study findings. These relationships need to be validated in other geographic areas. Cancer Epidemiol Biomarkers Prev; 26(4); 516-24. ©2017 AACRSee all the articles in this CEBP Focus section, "Geospatial Approaches to Cancer Control and Population Sciences."
Assuntos
Neoplasias da Mama/mortalidade , Disparidades nos Níveis de Saúde , Características de Residência/estatística & dados numéricos , Segregação Social , População Urbana/estatística & dados numéricos , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Idoso , Neoplasias da Mama/etnologia , Feminino , Hispânico ou Latino/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Vigilância da População , Modelos de Riscos Proporcionais , Fatores Socioeconômicos , Estados Unidos , População Branca/estatística & dados numéricos , Wisconsin , Adulto JovemRESUMO
Background: Residential racial segregation is still neglected in contemporary examinations of racial health disparities, including studies of cancer. Even fewer studies examine the processes by which segregation occurs, such as through housing discrimination. This study aims to examine relationships among housing discrimination, segregation, and colorectal cancer survival in southeastern Wisconsin.Methods: Cancer incidence data were obtained from the Wisconsin Cancer Reporting System for two southeastern Wisconsin metropolitan areas. Two indices of mortgage discrimination were derived from Home Mortgage Disclosure Act data, and a measure of segregation (the location quotient) was calculated from U.S. census data; all predictors were specified at the ZIP Code Tabulation Area level. Cox proportional hazards regression was used to examine associations between mortgage discrimination, segregation, and colorectal cancer survival in southeastern Wisconsin.Results: For all-cause mortality, racial bias in mortgage lending was significantly associated with a greater hazard rate among blacks [HR = 1.37; 95% confidence interval (CI), 1.06-1.76] and among black women (HR = 1.53; 95% CI, 1.06-2.21), but not black men in sex-specific models. No associations were identified for redlining or the location quotient. Additional work is needed to determine whether these findings can be replicated in other geographical settings.Conclusions: Our findings indicate that black women in particular experience poorer colorectal cancer survival in neighborhoods characterized by racial bias in mortgage lending, a measure of institutional racism. These findings are in line with previous studies of breast cancer survival.Impact: Housing discrimination and institutional racism may be important targets for policy change to reduce health disparities, including cancer disparities. Cancer Epidemiol Biomarkers Prev; 26(4); 561-8. ©2017 AACRSee all the articles in this CEBP Focus section, "Geospatial Approaches to Cancer Control and Population Sciences."
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Neoplasias Colorretais/mortalidade , Disparidades nos Níveis de Saúde , Habitação/estatística & dados numéricos , Segregação Social , Adolescente , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Características de Residência , Distribuição por Sexo , População Branca/estatística & dados numéricos , Wisconsin/epidemiologia , Adulto JovemRESUMO
Racial health disparities continue to be a serious problem in the United States and have been linked to contextual factors, including racial segregation. In some cases, including breast cancer survival, racial disparities appear to be worsening. Using the Home Mortgage Disclosure Act (HMDA) database, we extend current spatial analysis methodology to derive new, spatially continuous indices of (1) racial bias in mortgage lending and (2) redlining. We then examine spatial patterns of these indices and the association between these new measures and breast cancer survival among Black/African American women in the Milwaukee, Wisconsin metropolitan area. These new measures can be used to examine relationships between mortgage discrimination and patterns of disease throughout the United States.
Assuntos
Neoplasias da Mama/mortalidade , Sobreviventes de Câncer/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Habitação/estatística & dados numéricos , Racismo/estatística & dados numéricos , Análise Espacial , Negro ou Afro-Americano/estatística & dados numéricos , Neoplasias da Mama/diagnóstico , Feminino , Habitação/economia , Humanos , Pesquisa , Características de Residência , Fatores Socioeconômicos , WisconsinRESUMO
BACKGROUND: Cancer health disparities by race, ethnicity, socioeconomic status, and geography are a top public health priority. Breast and colorectal cancer, in particular, have been shown to exhibit significant disparities and contribute a large proportion of morbidity and mortality from cancer. In addition, breast and colorectal cancer offer targets for prevention and control, including nutrition, physical activity, screening, and effective treatments to prolong and enhance the quality of survival. However, despite the investment of significant time and resources over many years, breast and colorectal cancer disparities persist, and in some cases, may be growing. METHODS: This paper examines breast and colorectal cancer survival disparities in an 8-county region in southeastern Wisconsin, including the City of Milwaukee. Cox proportional hazards models were used to examine survival trends, and a new adaptation of adaptive spatial filtering--a disease mapping method--was used to examine spatial patterns of survival. RESULTS: Disparities by race and ethnicity are revealed, and spatial analyses identify specific areas within the study region that have lower than expected survival rates. CONCLUSIONS: Cancer control efforts in southeastern Wisconsin should focus on black/African American and Hispanic/Latina women to reduce breast cancer survival disparities, and black/African American populations to reduce colorectal cancer disparities. Evidence indicates that targeted interventions may be needed to serve populations in the Milwaukee and Kenosha metropolitan areas, as well as areas of Walworth, Ozaukee, and Waukesha counties.