TITLE: Racism, Residential Racial Segregation, and Breast Cancer Survival Disparities among Black, Hispanic and non-Hispanic White Women ABSTRACT/SUMMARY Racial disparities in breast cancer survival are significant, with only 68% of US Black women diagnosed with breast cancer remaining alive 10 years post-diagnosis, compared to 84% of White women. However, the size of the racial disparity in breast cancer mortality varies geographically across the US, from no observable state- level disparity between Black and White women in Minnesota and Massachusetts, to a mortality rate ratio of over 1.60 in Mississippi, Louisiana, and Wisconsin. Further, although the national survival gap between Hispanics and non-Hispanic Whites is small, national numbers mask substantial variation among subpopulations of Hispanics and poorer outcomes among Hispanics in some localities. Such geographical variation suggests that disparities are not inevitable, and this variation has not been explained. Racism and racial residential segregation are widely considered to contribute to health disparities, and may partially explain geographical variation in the size of the disparity. While some studies have shown that segregation is related to poor survival, others have found that this is not always the case, and some studies highlight the case of ethnic enclaves, which may be protective. Additionally, we have recently shown that a measure of racial bias in housing is associated with breast cancer survival among Black women in the Milwaukee area. We propose to build upon our previous work to undertake a national study of segregation and breast cancer survival with three aims: (1) Construct new and existing metrics of racism and segregation at the local level for the largest US metropolitan areas, and determine (a) how measures co-vary, (b) whether segregation measures predict stressors, social resources and opportunities at the local level, and (c) whether relationships differ by metropolitan area, (2) Determine whether measures of segregation are related to breast cancer survival disparities among Black, Hispanic and Non-Hispanic White women, and whether relationships are mediated by local stressors, social resources, or opportunities, and (3) Explore the ways in which Black and Hispanic breast cancer survivors in a highly segregated metropolitan area navigate cancer survivorship in the context of segregation. The interdisciplinary research team is well-positioned to conduct this work, with expertise in breast cancer, health disparities, geography, biostatistics, epidemiology, large database analysis, mediation analysis, qualitative research, and community engaged research. Further, we have established partnerships with numerous local community organizations working directly with breast cancer survivors in the Milwaukee area through a regional community advisory board, and have drawn upon these relationships to convene an advisory board specific to this project, engaged to guide and support data collection and interpret and disseminate research findings. The successful completion of the proposed work will support the development of future multi-sectoral interventions to reduce disparities by targeting local systems and policies.

Public Health Relevance

Racial and ethnic disparities in breast cancer survival are significant and persistent, and the size of these disparities varies geographically across the United States. Racism and racial residential segregation are widely considered to contribute to health disparities, and may partially explain geographical variation in the size of breast cancer survival disparities. We propose to undertake a national study of segregation and breast cancer survival among Black, Hispanic, and non-Hispanic women, by constructing and comparing segregation measures, determining whether segregation is associated with survival and via which pathways, and exploring the ways in which Black and Hispanic breast cancer survivors in a highly segregated metropolitan area navigate cancer survivorship in the context of segregation.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA214805-04
Application #
9925056
Study Section
Health Disparities and Equity Promotion Study Section (HDEP)
Program Officer
Gallicchio, Lisa M
Project Start
2017-05-08
Project End
2022-04-30
Budget Start
2020-05-01
Budget End
2021-04-30
Support Year
4
Fiscal Year
2020
Total Cost
Indirect Cost
Name
Medical College of Wisconsin
Department
Other Health Professions
Type
Schools of Medicine
DUNS #
937639060
City
Milwaukee
State
WI
Country
United States
Zip Code
53226