Background: U.S. women who identify as Black/African American (AA) or reside in socioeconomically disadvantaged neighborhoods have greater breast cancer (BrCa) mortality compared to White women or women in more affluent neighborhoods. While biologic factors – physiologic stress, epigenetics, etc. – possibly involved in these pathways are under study, few social mechanisms have been investigated. We hypothesized that neighborhood disorder (i.e., physical deterioration, lack of social control) might be a social mechanism potentiating poorer BrCa survival. Methods: Sociodemographic (age, race, ethnicity, health insurance, residential address), tumor (subtype, grade, stage), and vital status data were collected on primary, histologically-confirmed, invasive BrCa cases diagnosed among females from 2008-2013, age 20-74 years, from the New Jersey State Cancer Registry (NJSCR). Neighborhood auditing of Google Street View (GSV) scenes was conducted at 29,017 locations across NJ and neighborhood disorder scores were created from nine characteristics observed: Physical disorder (garbage/litter, graffiti, boarded/burned buildings, dumpsters, building conditions, yard conditions) and aesthetic engagement (team sports equipment, yard decorations, yard seating). Physical disorder and aesthetic engagement values were assigned to each BrCa case’s residential address at diagnosis by extracting values predicted by stochastic spatial interpolation (Universal Kriging). Census-based factors were census tract socioeconomic status (Yost Index), AA segregation (Gini and Isolation indices) and % AA. Cox proportional hazard models estimated hazard ratios (HR) and 95% confidence intervals (CI) of BrCa-specific mortality by physical disorder and aesthetic engagement. Median BrCa diagnosis date was 01/24/2011, median GSV image date was 09/2013, and follow-up was through 12/31/2014. Results: Of 22,390 women, 70.0% were White, 12.7% were AA, 10.4% were Latina, and there were 2,040 BrCa deaths. Over two-thirds of AA and Latina women lived in high physical disorder areas compared to 43% of White women. In models adjusted for all factors listed above, hazard of BrCa mortality was 24% higher (CI: 6-45) in areas of the greatest physical disorder quartile compared to the lowest physical disorder quartile. Adjustment for physical disorder and aesthetic engagement alone reduced the non-Latino AA vs non-Latino White HR by 13% (HRCrude=2.01, HRAdj = 1.75). Conclusions: Inequities in BrCa survival might be partially attributable to characteristics of “place” – physical disorder and aesthetics – that are beyond socioeconomic and racial composition. Future studies should collect additional data to enable robust bias investigation.
Citation Format: Jesse J Plascak, Andrew G Rundle, Stephen J Mooney, Mario Schootman, Antoinette M Stroup, Adana A.M. Llanos. Beyond socioeconomic and racial composition: Association between neighborhood disorder and breast cancer survival [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D004.