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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention
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Research Articles

Impact of Neighborhood and Individual Socioeconomic Status on Survival after Breast Cancer Varies by Race/Ethnicity: The Neighborhood and Breast Cancer Study

Salma Shariff-Marco, Juan Yang, Esther M. John, Meera Sangaramoorthy, Andrew Hertz, Jocelyn Koo, David O. Nelson, Clayton W. Schupp, Sarah J. Shema, Myles Cockburn, William A. Satariano, Irene H. Yen, Ninez A. Ponce, Marilyn Winkleby, Theresa H.M. Keegan and Scarlett L. Gomez
Salma Shariff-Marco
1Cancer Prevention Institute of California, Fremont; 2Stanford University, School of Medicine, Stanford; 3University of Southern California, School of Medicine, Los Angeles; 4University of California, Berkeley School of Public Health, Berkeley; 5University of California, San Francisco School of Medicine, San Francisco; and 6University of California, Los Angeles School of Public Health and Center for Health Policy Research, Los Angeles, California
1Cancer Prevention Institute of California, Fremont; 2Stanford University, School of Medicine, Stanford; 3University of Southern California, School of Medicine, Los Angeles; 4University of California, Berkeley School of Public Health, Berkeley; 5University of California, San Francisco School of Medicine, San Francisco; and 6University of California, Los Angeles School of Public Health and Center for Health Policy Research, Los Angeles, California
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Juan Yang
1Cancer Prevention Institute of California, Fremont; 2Stanford University, School of Medicine, Stanford; 3University of Southern California, School of Medicine, Los Angeles; 4University of California, Berkeley School of Public Health, Berkeley; 5University of California, San Francisco School of Medicine, San Francisco; and 6University of California, Los Angeles School of Public Health and Center for Health Policy Research, Los Angeles, California
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Esther M. John
1Cancer Prevention Institute of California, Fremont; 2Stanford University, School of Medicine, Stanford; 3University of Southern California, School of Medicine, Los Angeles; 4University of California, Berkeley School of Public Health, Berkeley; 5University of California, San Francisco School of Medicine, San Francisco; and 6University of California, Los Angeles School of Public Health and Center for Health Policy Research, Los Angeles, California
1Cancer Prevention Institute of California, Fremont; 2Stanford University, School of Medicine, Stanford; 3University of Southern California, School of Medicine, Los Angeles; 4University of California, Berkeley School of Public Health, Berkeley; 5University of California, San Francisco School of Medicine, San Francisco; and 6University of California, Los Angeles School of Public Health and Center for Health Policy Research, Los Angeles, California
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Meera Sangaramoorthy
1Cancer Prevention Institute of California, Fremont; 2Stanford University, School of Medicine, Stanford; 3University of Southern California, School of Medicine, Los Angeles; 4University of California, Berkeley School of Public Health, Berkeley; 5University of California, San Francisco School of Medicine, San Francisco; and 6University of California, Los Angeles School of Public Health and Center for Health Policy Research, Los Angeles, California
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Andrew Hertz
1Cancer Prevention Institute of California, Fremont; 2Stanford University, School of Medicine, Stanford; 3University of Southern California, School of Medicine, Los Angeles; 4University of California, Berkeley School of Public Health, Berkeley; 5University of California, San Francisco School of Medicine, San Francisco; and 6University of California, Los Angeles School of Public Health and Center for Health Policy Research, Los Angeles, California
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Jocelyn Koo
1Cancer Prevention Institute of California, Fremont; 2Stanford University, School of Medicine, Stanford; 3University of Southern California, School of Medicine, Los Angeles; 4University of California, Berkeley School of Public Health, Berkeley; 5University of California, San Francisco School of Medicine, San Francisco; and 6University of California, Los Angeles School of Public Health and Center for Health Policy Research, Los Angeles, California
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David O. Nelson
1Cancer Prevention Institute of California, Fremont; 2Stanford University, School of Medicine, Stanford; 3University of Southern California, School of Medicine, Los Angeles; 4University of California, Berkeley School of Public Health, Berkeley; 5University of California, San Francisco School of Medicine, San Francisco; and 6University of California, Los Angeles School of Public Health and Center for Health Policy Research, Los Angeles, California
1Cancer Prevention Institute of California, Fremont; 2Stanford University, School of Medicine, Stanford; 3University of Southern California, School of Medicine, Los Angeles; 4University of California, Berkeley School of Public Health, Berkeley; 5University of California, San Francisco School of Medicine, San Francisco; and 6University of California, Los Angeles School of Public Health and Center for Health Policy Research, Los Angeles, California
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Clayton W. Schupp
1Cancer Prevention Institute of California, Fremont; 2Stanford University, School of Medicine, Stanford; 3University of Southern California, School of Medicine, Los Angeles; 4University of California, Berkeley School of Public Health, Berkeley; 5University of California, San Francisco School of Medicine, San Francisco; and 6University of California, Los Angeles School of Public Health and Center for Health Policy Research, Los Angeles, California
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Sarah J. Shema
1Cancer Prevention Institute of California, Fremont; 2Stanford University, School of Medicine, Stanford; 3University of Southern California, School of Medicine, Los Angeles; 4University of California, Berkeley School of Public Health, Berkeley; 5University of California, San Francisco School of Medicine, San Francisco; and 6University of California, Los Angeles School of Public Health and Center for Health Policy Research, Los Angeles, California
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Myles Cockburn
1Cancer Prevention Institute of California, Fremont; 2Stanford University, School of Medicine, Stanford; 3University of Southern California, School of Medicine, Los Angeles; 4University of California, Berkeley School of Public Health, Berkeley; 5University of California, San Francisco School of Medicine, San Francisco; and 6University of California, Los Angeles School of Public Health and Center for Health Policy Research, Los Angeles, California
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William A. Satariano
1Cancer Prevention Institute of California, Fremont; 2Stanford University, School of Medicine, Stanford; 3University of Southern California, School of Medicine, Los Angeles; 4University of California, Berkeley School of Public Health, Berkeley; 5University of California, San Francisco School of Medicine, San Francisco; and 6University of California, Los Angeles School of Public Health and Center for Health Policy Research, Los Angeles, California
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Irene H. Yen
1Cancer Prevention Institute of California, Fremont; 2Stanford University, School of Medicine, Stanford; 3University of Southern California, School of Medicine, Los Angeles; 4University of California, Berkeley School of Public Health, Berkeley; 5University of California, San Francisco School of Medicine, San Francisco; and 6University of California, Los Angeles School of Public Health and Center for Health Policy Research, Los Angeles, California
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Ninez A. Ponce
1Cancer Prevention Institute of California, Fremont; 2Stanford University, School of Medicine, Stanford; 3University of Southern California, School of Medicine, Los Angeles; 4University of California, Berkeley School of Public Health, Berkeley; 5University of California, San Francisco School of Medicine, San Francisco; and 6University of California, Los Angeles School of Public Health and Center for Health Policy Research, Los Angeles, California
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Marilyn Winkleby
1Cancer Prevention Institute of California, Fremont; 2Stanford University, School of Medicine, Stanford; 3University of Southern California, School of Medicine, Los Angeles; 4University of California, Berkeley School of Public Health, Berkeley; 5University of California, San Francisco School of Medicine, San Francisco; and 6University of California, Los Angeles School of Public Health and Center for Health Policy Research, Los Angeles, California
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Theresa H.M. Keegan
1Cancer Prevention Institute of California, Fremont; 2Stanford University, School of Medicine, Stanford; 3University of Southern California, School of Medicine, Los Angeles; 4University of California, Berkeley School of Public Health, Berkeley; 5University of California, San Francisco School of Medicine, San Francisco; and 6University of California, Los Angeles School of Public Health and Center for Health Policy Research, Los Angeles, California
1Cancer Prevention Institute of California, Fremont; 2Stanford University, School of Medicine, Stanford; 3University of Southern California, School of Medicine, Los Angeles; 4University of California, Berkeley School of Public Health, Berkeley; 5University of California, San Francisco School of Medicine, San Francisco; and 6University of California, Los Angeles School of Public Health and Center for Health Policy Research, Los Angeles, California
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Scarlett L. Gomez
1Cancer Prevention Institute of California, Fremont; 2Stanford University, School of Medicine, Stanford; 3University of Southern California, School of Medicine, Los Angeles; 4University of California, Berkeley School of Public Health, Berkeley; 5University of California, San Francisco School of Medicine, San Francisco; and 6University of California, Los Angeles School of Public Health and Center for Health Policy Research, Los Angeles, California
1Cancer Prevention Institute of California, Fremont; 2Stanford University, School of Medicine, Stanford; 3University of Southern California, School of Medicine, Los Angeles; 4University of California, Berkeley School of Public Health, Berkeley; 5University of California, San Francisco School of Medicine, San Francisco; and 6University of California, Los Angeles School of Public Health and Center for Health Policy Research, Los Angeles, California
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DOI: 10.1158/1055-9965.EPI-13-0924 Published May 2014
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Article Figures & Data

Tables

  • Table 1.

    Characteristics of NABC patients with breast cancer (N = 4,639), San Francisco Bay Area, 1995 to 2008

    Non-Hispanic whiteAfrican-AmericanHispanicAsian-AmericanTotal
    n (%)n (%)n (%)n (%)Chi-square P-valuen (%)
    Total patients1,0679881,6426724,369
    Number of deaths
     All-cause27728025792906
     Breast cancer–specific157 (57)173 (62)162 (63)75 (82)567 (63)
    Study<0.01
     NC-BCFR high risk448 (42)241 (24)337 (21)259 (39)1,285 (29)
     NC-BCFR sporadic99 (9)293 (30)365 (22)413 (62)1,170 (27)
     SFBCS520 (49)454 (46)940 (57)0 (0)1,914 (44)
    Age at diagnosis (years)<0.01
     <3019 (2)11 (1)29 (2)14 (2)73 (2)
     30–3479 (7)32 (3)69 (4)48 (7)228 (5)
     35–3952 (5)53 (5)139 (9)55 (8)299 (7)
     40–44100 (9)121 (12)229 (14)115 (17)565 (13)
     45–49153 (14)162 (16)297 (18)127 (19)739 (17)
     50–54171 (16)180 (18)238 (15)119 (18)708 (16)
     55–59157 (15)142 (14)241 (14)106 (16)646 (15)
     60–64149 (14)152 (15)193 (12)88 (13)582 (13)
     65+187 (18)135 (14)207 (13)0 (0)529 (12)
    AJCC stage<0.01
     I535 (50)398 (40)685 (42)291 (43)1,909 (44)
     II429 (40)449 (45)742 (45)319 (48)1,939 (44)
     III53 (5)80 (8)143 (9)32 (5)308 (7)
     IV17 (2)25 (3)24 (2)13 (2)79 (2)
     Unknown33 (3)36 (4)48 (3)17 (3)134 (3)
    Nodal involvement<0.01
     No694 (65)576 (58)968 (59)397 (59)2,635 (60)
     Yes323 (30)363 (37)627 (38)255 (38)1,568 (36)
     Unknown50 (5)49 (5)47 (3)20 (3)166 (4)
    Histology0.19
     Ductal839 (79)786 (80)1299 (79)551 (82)3,475 (80)
     Lobular151 (14)112 (11)212 (13)72 (11)547 (12)
     Other77 (7)90 (9)131 (8)49 (7)347 (8)
    Histologic grade<0.01
     1192 (18)125 (13)243 (15)85 (13)645 (15)
     2423 (40)314 (32)592 (36)278 (41)1,607 (37)
     3 and 4324 (30)437 (44)654 (40)252 (38)1,667 (38)
     Unknown128 (12)112 (11)153 (9)57 (9)450 (10)
    Estrogen and progesterone receptor status<0.01
     ER and/or PR negative160 (15)261 (26)378 (23)127 (19)926 (21)
     ER/PR positive796 (75)627 (64)1,122 (68)476 (71)3,021 (69)
     Unknown111 (10)100 (10)142 (9)69 (10)422 (10)
    Surgerya<0.01
     None10 (1)40 (4)29 (2)12 (2)91 (2)
     Lumpectomy581 (55)592 (60)899 (55)317 (47)2,389 (55)
     Mastectomy475 (45)356 (36)714 (44)343 (51)1,888 (43)
    Radiation<0.01
     No421 (40)398 (40)656 (40)322 (48)1,797 (41)
     Yes646 (61)590 (60)986 (60)350 (52)2,572 (59)
    Chemotherapy<0.01
     No545 (51)453 (46)660 (40)248 (37)1,906 (44)
     Yes505 (47)519 (53)968 (59)417 (62)2,409 (55)
     Unknown17 (2)16 (2)14 (1)7 (1)54 (1)
    Education<0.01
     <High school45 (4)143 (15)606 (40)51 (8)845 (19)
     High school degree or equivalent175 (16)194 (20)349 (21)64 (10)782 (18)
     Vocational/technical degree or some college374 (35)430 (44)436 (27)176 (26)1,416 (32)
     College degree/graduate school473 (44)221 (22)251 (15)381 (57)1,326 (30)
    Neighborhood (block group) SESb<0.01
     Quintile 1-low SES9 (1)132 (13)98 (6)9 (1)248 (6)
     Quintile 230 (3)282 (29)240 (15)31 (5)583 (13)
     Quintile 3100 (9)207 (21)363 (22)101 (15)771 (18)
     Quintile 4257 (24)216 (22)434 (26)164 (24)1,071 (25)
     Quintile 5-high SES671 (63)151 (15)507 (31)367 (55)1,696 (39)
    % Poverty (block group)<0.01
     0–0.049, high SES627 (59)202 (20)591 (36)350 (52)1,770 (41)
     0.05–0.09279 (26)191 (19)429 (26)199 (30)1,098 (25)
     0.1–0.19135 (13)317 (32)438 (27)94 (14)984 (23)
     ≥0.2, low SES26 (2)278 (28)184 (11)29 (4)517 (12)
    Marital status<0.01
     Single/never married164 (15)282 (29)258 (16)98 (15)802 (18)
     Married681 (64)397 (40)1,018 (62)522 (78)2,618 (60)
     Separated/divorced114 (11)197 (20)207 (12)34 (5)552 (13)
     Widowed78 (7)86 (9)119 (7)10 (2)293 (7)
     Unknown30 (3)26 (3)40 (2)8 (1)104 (2)
    History of benign breast disease<0.01
     No817 (77)794 (80)1,405 (86)576 (86)3,592 (82)
     Yes250 (23)192 (19)234 (14)96 (14)772 (18)
     Unknown0 (0)2 (0)3 (0)0 (0)5 (0)
    Years since last full-term pregnancy<0.01
     Nulliparous272 (26)180 (18)234 (14)173 (26)859 (20)
     <225 (2)14 (1)21 (1)17 (3)77 (2)
     2–440 (4)26 (3)82 (5)47 (7)195 (5)
     5+726 (68)767 (78)1,303 (79)435 (65)3,231 (74)
     Unknown4 (0)1 (0)2 (0)0 (0)7 (0)
    History of oral contraceptive use<0.01
     No285 (27)271 (27)535 (33)365 (54)1,456 (33)
     Yes730 (68)679 (69)1,052 (64)306 (46)2,767 (63)
     Unknown52 (5)38 (4)55 (3)1 (0)146 (3)
    History of menopausal hormone therapy usec<0.01
     No540 (51)686 (70)1,126 (69)514 (77)2,866 (66)
     Past197 (19)201 (20)232 (14)90 (13)720 (17)
     Recent330 (31)101 (10)284 (17)68 (10)783 (18)
    Alcohol consumption (g/day) in the year before diagnosis<0.01
     0380 (36)614 (62)1,045 (64)617 (92)2,656 (61)
     <5240 (23)125 (13)263 (16)21 (3)649 (15)
     5–9135 (13)97 (10)107 (7)12 (2)351 (8)
     10–14109 (10)48 (5)99 (6)9 (1)265 (6)
     ≥15196 (18)101 (10)124 (8)10 (2)431 (10)
     Unknown7 (1)3 (0)4 (0)3 (0)17 (0)
    BMI (kg/m2) in year before diagnosis<0.01
     <25.0604 (57)262 (27)529 (32)471 (70)1,866 (43)
     25.0–29.9257 (24)312 (32)543 (33)146 (22)1,258 (29)
     ≥30.0197 (19)400 (41)549 (33)48 (7)1,194 (27)
     Unknown9 (1)14 (1)21 (1)7 (1)51 (1)
    Recent recreational physical activity (hours/week)<0.01
     0, None260 (24)288 (29)686 (42)211 (31)1,445 (33)
     Quartiles 1 & 2330 (31)460 (47)476 (29)241 (36)1,507 (35)
     Quartile 3 & 4476 (45)240 (24)479 (29)218 (32)1,413 (32)
     Unknown1 (0)0 (0)1 (0)2 (0)4 (0)
    Percent of race/ethnic-concordant patients with cancer in reporting hospital (%)<0.01
     <251 (0)646 (65)1456 (89)562 (84)2,665 (61)
     25–4970 (7)342 (35)186 (11)86 (13)684 (16)
     50–74472 (44)0 (0)0 (0)10 (2)482 (11)
     ≥75524 (49)0 (0)0 (0)14 (2)538 (12)
    Percent of patients with cancer in highest SES quintile in reporting hospital (%)<0.01
     <25169 (16)317 (32)420 (26)124 (19)1,030 (24)
     25–49286 (27)491 (50)492 (30)249 (37)1,518 (35)
     50–74521 (49)163 (17)659 (40)251 (37)1,594 (37)
     ≥7591 (9)17 (2)71 (4)48 (7)227 (5)
    • ↵aDistributions are based on known status.

    • ↵bNeighborhood SES was measured using a composite measure of 7 Census indicator measures known as the Yost SES Index (29).

    • ↵cPast = stopped before diagnosis; recent = stopped or continued to use at diagnosis.

  • Table 2.

    Distributions of education and neighborhood SES by race/ethnicity for NABC patients with breast cancer, San Francisco Bay Area, 1995 to 2008

    Education
    <High school graduationHigh school graduationVocational school/some collegeCollege+Totala
    Neighborhood SESbN (%)N (%)N (%)N (%)N (%)
    Non-Hispanic white
     Neighborhood SES
      Q1-low SES1 (11.1)3 (33.3)3 (33.3)2 (22.2)9 (0.8)
      Q23 (10.0)8 (26.7)14 (46.7)5 (16.7)30 (2.8)
      Q312 (12.0)24 (24.0)41 (41.0)23 (23.0)100 (9.4)
      Q421 (8.1)52 (20.2)86 (33.3)98 (38.0)258 (24.2)
      Q5-high SES8 (1.2)88 (13.1)230 (34.3)345 (51.4)671 (62.8)
      Total45 (4.2)175 (16.4)374 (35.0)473 (44.3)1,068 (100.0)
    African-American
     Neighborhood SES
      Q1-low SES38 (28.6)34 (25.6)51 (38.3)9 (6.8)133 (13.4)
      Q255 (19.4)59 (20.8)133 (46.8)35 (12.3)284 (28.6)
      Q323 (11.0)46 (22.0)93 (44.5)45 (21.5)209 (21.0)
      Q419 (8.8)39 (18.1)103 (47.7)55 (25.5)216 (21.8)
      Q5-high SES8 (5.3)16 (10.6)50 (33.1)77 (51.0)151 (15.2)
      Total143 (14.4)194 (19.5)430 (43.3)221 (22.3)993 (100.0)
    Hispanic
     Neighborhood SES
      Q1-low SES64 (64.6)13 (13.1)16 (16.2)5 (5.1)99 (5.9)
      Q2146 (58.9)42 (16.9)41 (16.5)11 (4.4)248 (14.9)
      Q3184 (49.2)75 (20.1)75 (20.1)29 (7.8)374 (22.4)
      Q4123 (28.0)115 (26.1)126 (28.6)70 (15.9)440 (26.3)
      Q5-high SES89 (17.5)104 (20.4)178 (35.0)136 (26.7)509 (30.5)
      Total606 (36.3)349 (20.9)436 (26.1)251 (15.0)1,670 (100.0)
    Asian-American
     Neighborhood SES
      Q1-low SES3 (33.3)2 (22.2)1 (11.1)3 (33.3)9 (1.3)
      Q27 (22.6)8 (25.8)8 (25.8)8 (25.8)31 (4.6)
      Q314 (13.9)16 (15.8)22 (21.8)49 (48.5)101 (15.0)
      Q414 (8.5)19 (11.6)57 (34.8)74 (45.1)164 (24.3)
      Q5-high SES13 (3.5)19 (5.1)88 (23.8)247 (66.9)369 (54.7)
      Total51 (7.6)64 (9.5)176 (26.1)381 (56.5)674 (100.0)
    • ↵aTotals include patients with unknown education, and therefore row numbers may not add up to the total. Note that those with unknown education were excluded from the analytic sample.

    • ↵bNeighborhood SES was measured using a composite measure of 7 Census indicator measures known as the YOST SES Index (29).

  • Table 3.

    Association of individual and neighborhood SES with all-cause mortality by race/ethnicity: HRs with 95% CIs, San Francisco Bay Area, 1995 to 2008 (with follow-up through 2009)

    Non-Hispanic whiteAfrican-AmericanHispanicAsian-American
    Base modelaBase + education + nSES modelbBase modelaBase + education + nSES modelbBase modelaBase + education + nSES modelbBase modelaBase + education + nSES modelb
    SES variablesHR (95% CI)HR (95% CI)HR (95% CI)HR (95% CI)HR (95% CI)HR (95% CI)HR (95% CI)HR (95% CI)
    Education
     College degree+1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     Vocational/some college1.03 (0.78–1.36)1.01 (0.76–1.34)0.92 (0.65–1.31)0.88 (0.62–1.26)1.31 (0.83–2.06)1.25 (0.79–1.97)1.29 (0.74–2.23)1.11 (0.63–1.97)
     = High school degreec1.27 (0.92–1.74)1.19 (0.86–1.65)1.03 (0.69–1.54)0.92 (0.60–1.40)1.20 (0.75–1. 92)1.08 (0.66–1.77)2.13 (1.28–3.52)1.53 (0.89–2.62)
     <High school degree1.40 (0.96–2.06)1.20 (0.80–1.80)1.38 (0.90–2.11)1.15 (0.73–1.81)
      Ptrend0.170.340.050.310.190.760.010.13
    Neighborhood SES (nSES)e
     Q5-high SES1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     Q41.15 (0.86–1.54)1.12 (0.84–1.50)0.65 (0.41–1.02)0.66 (0.42–1.03)1.12 (0.77–1.63)1.12 (0.76–1.64)2.14 (1.31–3.51)1.99 (1.19–3.34)
     Q31.28 (0.86–1.91)1.24 (0.83–1.85)1.03 (0.67–1.59)1.03 (0.66–1.61)1.38 (0.96–1.99)1.37 (0.92–2.02)2.29 (1.24–4.23)2.02 (1.07–3.82)
     Q2d1.64 (0.91–2.94)1.56 (0.86–2.83)1.17 (0.80–1.71)1.16 (0.78–1.71)1.59 (1.07–2.36)1.57 (1.03–2.38)3.79 (1.89–7.61)3.18 (1.51–6.70)
     Q1-low SES1.33 (0.86–2.05)1.29 (0.82–2.03)1.59 (0.94–2.67)1.57 (0.92–2.71)
      Ptrend0.050.080.010.030.010.010.010.01
    Education and nSESf
     ≥Some college, high nSES1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     ≥Some college, low nSES1.22 (0.78–1.91)1.61 (1.16–2.25)1.41 (0.89–2.23)1.89 (1.02–3.50)
     ≤HS degree, high nSES1.19 (0.86–1.63)1.44 (0.86–2.42)0.99 (0.70–1.41)1.84 (1.00–3.38)
     ≤HS degree, low nSES1.62 (1.02–2.56)1.67 (1.20–2.32)1.39 (1.01–1.92)2.68 (1.37–5.23)

    NOTE: Bold font refers to statistically significant associations.

    • ↵aAdjusted for age at diagnosis (continuous), year of diagnosis (continuous), study eligibility [Northern California site of the Breast Cancer Family Registry (NC-BCFR) high risk, NC-BCFR sporadic, SFBCS], nodal involvement (no, yes, unknown), histology (ductal, lobular, other), histologic grade (1–4, unknown), joint ERPR status (ER−PR−, ER+, or PR+, unknown), type of surgery (none, lumpectomy, mastectomy, not otherwise specified, unknown), radiation (no, yes, unknown), chemotherapy (no, yes, unknown), subsequent primary tumor (yes, no) and clustering by block group, and stratified by AJCC stage (I–IV, unknown).

    • ↵bAdjusted for covariates of model 1 and clustering by block group (individual education and neighborhood SES in the same model), and stratified by AJCC stage (I–IV, unknown).

    • ↵cEducation levels <high school graduate and high school graduate collapsed as for non-Hispanic whites and Asian-Americans because of small sample sizes.

    • ↵dNeighborhood SES quintiles 1 and 2 were collapsed for non-Hispanic whites and Asian-Americans because of small sample sizes.

    • ↵eNeighborhood SES was measured using a composite measure of 7 Census indicator measures known as the YOST SES Index (29).

    • ↵fHS, high school. Education levels (<high school graduate and high school graduate) collapsed as ≤ high school graduate. Neighborhood SES levels collapsed as Q1 to Q3: low SES; Q4 to Q5: high SES.

  • Table 4.

    Association of individual and neighborhood SES with all-cause mortality adjusted for reproductive factors, marital status, behavioral factors, and hospital characteristics, by race/ethnicity: HRs with 95% CIs, San Francisco Bay Area, 1995 to 2008 (with follow-up through 2009)

    All-cause mortality
    CasesDeathsBase + SES + reproductive factor modelaBase + SES + marital status modelbBase + SES + behavioral factors modelcBase + SES + hospital characteristics modeld
    SES variablesn (%)n (%)HR (95% CI)HR (95% CI)HR (95% CI)HR (95% CI)
    Non-Hispanic whites
    Education
     College+473 (44.3%)112 (40.4%)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     Vocational/some college374 (35.1%)95 (34.3%)1.01 (0.76–1.34)1.01 (0.76–1.34)0.96 (0.72–1.28)1.05 (0.78–1.40)
     ≤High school graduatee220 (20.6%)70 (25.3%)1.18 (0.85–1.63)1.23 (0.89–1.69)1.09 (0.78–1.53)1.25 (0.90–1.73)
      Ptrend0.370.260.660.21
    Neighborhood SES (nSES)f
     Q5-high SES671 (62.9%)161 (58.1%)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     Q4257 (24.1%)70 (25.3%)1.11 (0.82–1.50)1.09 (0.81–1.47)1.08 (0.80–1.45)1.09 (0.81–1.46)
     Q3100 (9.4%)32 (11.6%)1.24 (0.83–1.85)1.18 (0.78–1.77)1.17 (0.78–1.79)1.18 (0.78–1.79)
     Q1, Q2-low SES39 (3.7%)14 (5.1%)1.49 (0.82–2.72)1.51 (0.84–2.72)1.51 (0.81–2.80)1.48 (0.79–2.76)
      Ptrend0.120.150.170.18
    Education and nSESg
     ≥ College, high nSES759 (71.1%)180 (65.0%)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     ≥ College, low nSES88 (8.3%)27 (9.8%)1.19 (0.76–1.86)1.18 (0.75–1.85)1.18 (0.76–1.85)1.17 (0.73–1.85)
     ≤ High school graduate, high nSES169 (15.8%)51 (18.4%)1.16 (0.83–1.61)1.21 (0.88–1.66)1.12 (0.81–1.55)1.20 (0.88–1.65)
     ≤ High school graduate, low nSES51 (4.8%)19 (6.9%)1.62 (1.03–2.54)1.59 (1.01–2.51)1.44 (0.90–2.28)1.60 (0.99–2.60)
    African-Americans
    Education(N = 980)(N = 280)
     College+221 (22.4%)49 (17.5%)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     Vocational/some college430 (43.5%)112 (40.0%)0.90 (0.62–1.31)0.89 (0.62–1.29)0.86 (0.60–1.25)0.91 (0.63–1.31)
     High school graduate194 (19.6%)59 (21.1%)0.91 (0.58–1.41)0.94 (0.62–1.44)0.87 (0.56–1.35)0.97 (0.63–1.50)
     <High school graduate143 (14.5%)60 (21.4%)1.18 (0.78–1.80)1.24 (0.82–1.88)1.17 (0.77–1.77)1.26 (0.83–1.90)
      Ptrend0.380.240.400.20
    Neighborhood SES (nSES)f
     Q5-high SES151 (15.3%)42 (15.0%)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     Q4216 (21.9%)46 (16.4%)0.67 (0.42–1.05)0.64 (0.41–1.01)0.68 (0.43–1.08)0.65 (0.41–1.03)
     Q3207 (21.0%)54 (19.3%)0.99 (0.62–1.59)1.02 (0.64–1.61)0.98 (0.63–1.55)1.04 (0.65–1.66)
     Q2282 (28.5%)88 (31.4%)1.11 (0.75–1.66)1.14 (0.77–1.69)1.16 (0.78–1.72)1.09 (0.72–1.66)
     Q1-low SES132 (13.4%)50 (17.9%)1.26 (0.79–2.01)1.29 (0.81–2.03)1.29 (0.81–2.04)1.19 (0.73–1.92)
      Ptrend0.040.020.030.06
    Education and nSESg
     ≥ College, high nSES285 (28.9%)61 (21.8%)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     ≥ College, low nSES366 (37.0%)100 (35.7%)1.62 (1.15–2.27)1.62 (1.15–2.27)1.57 (1.12–2.20)1.58 (1.12–2.22)
     ≤ High school graduate, high nSES82 (8.3%)27 (9.6%)1.53 (0.91–2.57)1.44 (0.86–2.42)1.44 (0.85–2.42)1.46 (0.87–2.47)
     ≤ High school graduate, low nSES255 (25.8%)92 (32.9%)1.58 (1.11–2.23)1.70 (1.22–2.36)1.58 (1.13–2.22)1.68 (1.20–2.35)
    Hispanics
    Education(N = 1,642)(N = 257)
     College+251 (15.3%)29 (11.3%)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     Vocational/some college436 (26.6%)58 (22.6%)1.20 (0.75–1.89)1.24 (0.78–1.97)1.24 (0.78–1.95)1.23 (0.78–1.94)
     High school graduate349 (21.3%)50 (19.5%)1.06 (0.64–1.74)1.11 (0.67–1.83)1.06 (0.64–1.74)1.07 (0.65–1.75)
     <High school graduate606 (36.9%)120 (46.7%)1.04 (0.65–1.64)1.17 (0.74–1.86)1.06 (0.66–1.71)1.06 (0.67–1.68)
     Ptrend0.790.720.820.85
    Neighborhood SES (nSES)f
     Q5-high SES507 (30.9%)67 (26.1%)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     Q4434 (26.4%)65 (25.3%)1.14 (0.77–1.67)1.13 (0.77–1.66)1.08 (0.74–1.59)1.07 (0.73–1.57)
     Q3363 (22.1%)62 (24.1%)1.33 (0.89–1.97)1.35 (0.91–2.00)1.29 (0.86–1.92)1.27 (0.86–1.88)
     Q2240 (14.6%)48 (18.7%)1.65 (1.08–2.50)1.61 (1.07–2.43)1.50 (0.99–2.27)1.41 (0.91–2.17)
     Q1-low SES98 (6.0%)15 (5.8%)1.51 (0.87–2.61)1.65 (0.97–2.82)1.55 (0.91–2.64)1.36 (0.78–2.39)
      Ptrend0.01<0.010.020.08
    Education and nSESg
     ≥ College, high nSES510 (31.1%)64 (24.9%)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     ≥ College, low nSES177 (10.8%)23 (9.0%)1.34 (0.86–2.10)1.40 (0.89–2.23)1.34 (0.84–2.13)1.26 (0.79–2.03)
     ≤ High school graduate, high nSES431 (26.3%)68 (26.5%)0.94 (0.65–1.35)1.02 (0.71–1.45)0.93 (0.64–1.34)0.93 (0.65–1.33)
     ≤ High school graduate, low nSES524 (31.9%)102 (39.7%)1.29 (0.93–1.80)1.43 (1.04–1.98)1.25 (0.87–1.78)1.20 (0.85–1.71)
    Asian-Americans
    Education(N = 672)(N = 92)
     College+381 (56.7%)41 (44.6%)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     Vocational/some college176 (26.2%)24 (26.1%)1.19 (0.66–2.15)1.18 (0.65–2.15)1.03 (0.58–1.85)1.08 (0.61–1.90)
     ≤ High school graduatee115 (17.1%)27 (29.4%)1.45 (0.83–2.53)1.57 (0.90–2.73)1.31 (0.69–2.47)1.46 (0.84–2.53)
      Ptrend0.200.120.450.21
    Neighborhood SES (nSES)f
     Q5-high SES367 (54.6%)38 (41.3%)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     Q4164 (24.4%)27 (29.4%)1.85 (1.09–3.11)1.91 (1.13–3.23)2.01 (1.17–3.47)1.93 (1.15–3.25)
     Q3101 (15.0%)18 (19.6%)1.79 (0.91–3.54)1.93 (1.00–3.69)1.89 (1.00–3.54)1.86 (0.95–3.62)
     Q1, Q2-low SES40 (6.0%)9 (9.8%)3.20 (1.52–6.73)2.68 (1.17–6.13)3.11 (1.42–6.78)3.05 (1.39–6.70)
      Ptrend<0.01<0.01<0.01<0.01
    Education and nSESg
     ≥College, high nSES466 (69.4%)50 (54.4%)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     ≥College, low nSES91 (13.5%)15 (16.3%)1.85 (0.99–3.47)1.72 (0.91–3.27)1.78 (0.96–3.29)1.62 (0.80–3.27)
     ≤High school graduate, high nSES65 (9.7%)15 (16.3%)1.79 (0.94–3.42)1.82 (0.97–3.40)1.67 (0.82–3.43)1.64 (0.88–3.05)
     ≤High school graduate, low nSES50 (7.4%)12 (13.0%)2.32 (1.13–4.78)2.54 (1.26–5.10)2.21 (1.06–4.60)2.43 (1.20–4.92)

    NOTE: Bold font refers to statistically significant associations.

    • ↵aAdjusted for age at diagnosis (continuous), year of diagnosis (continuous), study eligibility (NC-BCFR high risk, NC-BCFR sporadic, SFBCS), histology (ductal, lobular, other), histologic grade (1–4, unknown), joint ERPR status (ER−PR−, ER+, or PR+, unknown), nodal involvement (none, positive, unknown), type of surgery (none, lumpectomy, mastectomy, NOS, unknown), radiation (no, yes, unknown), chemotherapy (no, yes, unknown), first subsequent primary tumor (yes, no), second subsequent primary tumor (yes, no), days between the dates of diagnosis of study qualifying tumor and the first subsequent tumor (continuous), days between the dates of diagnosis of the first and second subsequent tumor (continuous), benign breast disease (no, yes, unknown), years since last full-term pregnancy (≤2, 2–4, 5±, unknown), prediagnosis hormonal contraception use (never, ever, unknown), prediagnosis hormone therapy use (never, past, recent, unknown) and clustering by block group, and stratified by AJCC stage (I– IV, unknown).

    • ↵bAdjusted for age at diagnosis (continuous), study eligibility (NC-BCFR high risk, NC-BCFR sporadic, SFBCS), histology (ductal, lobular, other), histologic grade (1–4, unknown), joint ERPR status (ER−PR−, ER+, or PR+, unknown), nodal involvement (none, positive, unknown), type of surgery (none, lumpectomy, mastectomy, NOS, unknown), radiation (no, yes, unknown), chemotherapy (no, yes, unknown), first subsequent primary tumor (yes, no), second subsequent primary tumor (yes, no), days between the dates of diagnosis of study qualifying tumor and the first subsequent tumor (continuous), days between the dates of diagnosis of the first and second subsequent tumor (continuous), marital status (single/never married, married, separated/divorced, widowed, unknown) and clustering by block group, and stratified by AJCC stage (I–IV, unknown).

    • ↵cAdjusted for age at diagnosis (continuous), study eligibility (NC-BCFR high risk, NC-BCFR sporadic, SFBCS), histology (ductal, lobular, other), histologic grade (1–4, unknown), joint ERPR status (ER−PR−, ER+, or PR+, unknown), nodal involvement (none, positive, unknown), type of surgery (none, lumpectomy, mastectomy, NOS, unknown), radiation (no, yes, unknown), chemotherapy (no, yes, unknown), first subsequent primary tumor (yes, no), second subsequent primary tumor (yes, no), days between the dates of diagnosis of study qualifying tumor and the first subsequent tumor (continuous), days between the dates of diagnosis of the first and second subsequent tumor (continuous), grams per day of alcohol in reference year (0, ≤5, 5–9, 10–14, 15±, unknown), prediagnosis BMI (≤25, 25–29, 30±, unknown), recent recreational physical activity (0, Q1/Q2, Q3/Q4, unknown) and clustering by block group, and stratified by AJCC stage (I–IV, unknown).

    • ↵dAdjusted for age at diagnosis (continuous), study eligibility (NC-BCFR high risk, NC-BCFR sporadic, SFBCS), histology (ductal, lobular, other), histologic grade (1–4, unknown), joint ERPR status (ER−PR−, ER+, or PR+, unknown), nodal involvement (none, positive, unknown), type of surgery (none, lumpectomy, mastectomy, NOS, unknown), radiation (no, yes, unknown), chemotherapy (no, yes, unknown), first subsequent primary tumor (yes, no), second subsequent primary tumor (yes, no), days between the dates of diagnosis of study qualifying tumor and the first subsequent tumor (continuous), days between the dates of diagnosis of the first and second subsequent tumor (continuous), percent of white patients with cancer in reporting hospital (≤25%, 25–49%, 50–74%, ≥75%, unknown), percent of patients with cancer in highest SES quintile in reporting hospital (≤25%, 25–49%, 50–74%, ≥75%, unknown) and clustering by block group, and stratified by AJCC stage (I–IV, unknown).

    • ↵eEducation levels (<high school graduate and high school graduate) collapsed as ≤ high school graduate.

    • ↵fNeighborhood SES was measured using a composite measure of 7 Census indicator measures known as the Yost SES Index (29).

    • ↵gSES levels collapsed as Q1 to Q3: low SES; Q4 to Q5: high SES.

  • Table 5.

    Association of individual and neighborhood SES with breast cancer–specific mortality by race/ethnicity: HRs with 95% CIs, San Francisco Bay Area, 1995 to 2008 (with follow-up through 2009)

    Non-Hispanic whiteAfrican-AmericanHispanicAsian-American
    Base modelaBase + education + SES modelbBase modelaBase + education + SES modelbBase modelaBase + education + SES modelbBase modelaBase + education + SES modelb
    SES variablesHR (95% CI)HR (95% CI)HR (95% CI)HR (95% CI)HR (95% CI)HR (95% CI)HR (95% CI)HR (95% CI)
    Education
     College degree+1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     Vocational/some college0.87 (0.59–1.29)0.87 (0.59–1.29)0.74 (0.49–1.14)0.70 (0.45–1.09)1.41 (0.83–2.37)1.36 (0.80–2.32)1.11 (0.59–2.09)0.93 (0.49–1.76)
     = High school degreec1.15 (0.75–1.77)1.14 (0.73–1.77)0.65 (0.39–1.10)0.56 (0.32–1.00)1.17 (0.66–2.08)1.09 (0.60–2.00)1.93 (1.09–3.43)1.23 (0.66–2.31)
     <High school degree0.97 (0.59–1.60)0.83 (0.49–1.40)1.37 (0.82–2.27)1.22 (0.70–2.13)
      Ptrend0.700.740.610.310.430.860.040.51
    Neighborhood SESe
     Q5-high SES1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     Q41.12 (0.76–1.65)1.09 (0.73–1.62)0.63 (0.37–1.09)0.67 (0.39–1.15)0.85 (0.54–1.35)0.84 (0.53–1.36)2.63 (1.51–4.60)2.55 (1.42–4.58)
     Q31.02 (0.61–1.70)1.00 (0.59–1.68)0.78 (0.45–1.37)0.88 (0.50–1.57)1.05 (0.67–1.66)1.03 (0.63–1.69)2.97 (1.47–5.98)2.78 (1.36–5.71)
     Q2d1.08 (0.41–2.87)1.05 (0.40–2.75)0.95 (0.60–1.52)1.08 (0.67–1.74)1.41 (0.87–2.30)1.38 (0.83–2.30)4.25 (1.99–9.08)3.91 (1.72–8.91)
     Q1-low SES1.20 (0.71–2.02)1.42 (0.81–2.47)1.48 (0.78–2.84)1.47 (0.74–2.91)
      Ptrend0.750.800.170.100.100.140.010.01
    Education and nSESf
     ≥Some college, high nSES1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     ≥Some college, low nSES0.78 (0.41–1.50)1.45 (0.99–2.14)1.08 (0.59–1.97)2.26 (1.14–4.49)
     ≤HS degree, high nSES1.09 (0.69–1.73)1.25 (0.65–2.43)0.84 (0.52–1.34)1.74 (0.88–3.44)
     ≤HS degree, low nSES1.52 (0.82–2.82)1.11 (0.72–1.70)1.24 (0.83–1.86)2.82 (1.29–6.14)

    NOTE: Bold font refers to statistically significant associations.

    • ↵aAdjusted for age at diagnosis (continuous), year of diagnosis (continuous), study eligibility (FRBC high risk, case–control, FRBC sporadic), nodal involvement (no, yes, unknown), histology (ductal, lobular, other), histologic grade (1–4, unknown), joint ERPR status (ER−PR−, ER+, or PR+, unknown), type of surgery (none, lumpectomy, mastectomy, NOS, unknown), radiation (no, yes, unknown), chemotherapy (no, yes, unknown), subsequent primary tumor (yes, no) and clustering by block group, and stratified by AJCC stage (I–IV, unknown).

    • ↵bAdjusted for covariates of model 1 and clustering by block group (individual education and neighborhood SES in the same model), and stratified by AJCC stage (I–IV, unknown).

    • ↵cEducation levels (<high school graduate and high school graduate) collapsed as ≤ high school graduate for non-Hispanic whites and Asian-Americans because of small sample sizes.

    • ↵dNeighborhood SES quintiles 1 and 2 were collapsed for non-Hispanic whites and Asian-Americans because of small sample sizes.

    • ↵eNeighborhood SES was measured using a composite measure of 7 Census indicator measures known as the YOST SES Index (29).

    • ↵fHS, high school. Education levels (<high school graduate and high school graduate) collapsed as ≤ high school graduate. Neighborhood SES levels collapsed as Q1 to Q3: low SES; Q4 to Q5: high SES.

  • Table 6.

    Association of individual and neighborhood SES with breast cancer–specific mortality adjusted for reproductive factors, marital status, behavioral factors, and hospital characteristics, by race/ethnicity: HRs with 95% CIs, San Francisco Bay Area, 1995 to 2008 (with follow-up through 2009)

    Breast cancer mortality
    CasesDeathsBase + SES + reproductive factor modelaBase + SES + marital status modelbBase + SES + behavioral factors modelcBase + SES + hospital characteristics modeld
    SES variablesn (%)n (%)HR (95% CI)HR (95% CI)HR (95% CI)HR (95% CI)
    Non-Hispanic whites
    Education(N = 1,067)(N = 157)
     College+473 (44.3%)74 (47.1%)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     Vocational/some college374 (35.1%)49 (31.2%)0.89 (0.60–1.31)0.90 (0.61–1.33)0.89 (0.59–1.33)0.91 (0.60–1.38)
     ≤ High school graduatee220 (20.6%)34 (21.7%)1.13 (0.72–1.76)1.17 (0.76–1.82)1.12 (0.71–1.76)1.16 (0.74–1.82)
      Ptrend0.750.630.760.64
    Neighborhood SES (nSES)f
     Q5-high SES671 (62.9%)93 (59.2%)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     Q4257 (24.1%)42 (26.8%)1.07 (0.71–1.60)1.06 (0.71–1.60)1.07 (0.71–1.61)0.97 (0.64–1.46)
     Q3100 (9.4%)16 (10.2%)0.95 (0.55–1.64)0.91 (0.53–1.58)0.94 (0.56–1.57)0.81 (0.46–1.43)
     Q1, Q2-low SES39 (3.7%)6 (3.8%)1.01 (0.38–2.70)1.02 (0.40–2.61)1.12 (0.44–2.86)0.84 (0.30–2.34)
      Ptrend1.000.940.920.52
    Education and nSESg
     ≥ College, high nSES759 (71.1%)111 (70.7%)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     ≥ College, low nSES88 (8.3%)12 (7.6%)0.74 (0.38–1.43)0.74 (0.39–1.42)0.78 (0.41–1.46)0.64 (0.33–1.27)
     ≤ High school graduate, high nSES169 (15.8%)24 (15.3%)1.06 (0.66–1.69)1.11 (0.71–1.76)1.07 (0.67–1.72)1.06 (0.67–1.68)
     ≤ High school graduate, low nSES51 (4.8%)10 (6.4%)1.48 (0.80–2.75)1.43 (0.75–2.70)1.44 (0.78–2.68)1.33 (0.69–2.53)
    African-Americans
    Education(N = 980)(N = 173)
     College+221 (22.4%)38 (22.0%)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     Vocational/some college430 (43.5%)78 (45.1%)0.67 (0.42–1.07)0.70 (0.45–1.10)0.68 (0.42–1.08)0.72 (0.46–1.13)
     High school graduate194 (19.6%)31 (17.9%)0.52 (0.29–0.95)0.58 (0.33–1.03)0.55 (0.30–1.00)0.58 (0.33–1.04)
     <High school graduate143 (14.5%)26 (15.0%)0.79 (0.46–1.36)0.92 (0.53–1.58)0.84 (0.49–1.45)0.87 (0.51–1.46)
      Ptrend0.250.480.360.39
    Neighborhood SES (nSES)f
     Q5-high SES151 (15.3%)29 (16.8%)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     Q4216 (21.9%)33 (19.1%)0.69 (0.40–1.20)0.68 (0.39–1.18)0.67 (0.39–1.16)0.66 (0.38–1.14)
     Q3207 (21.0%)29 (16.8%)0.85 (0.47–1.56)0.91 (0.50–1.67)0.81 (0.45–1.45)0.89 (0.50–1.58)
     Q2282 (28.5%)53 (30.6%)1.11 (0.68–1.81)1.12 (0.68–1.83)1.02 (0.62–1.67)1.04 (0.63–1.72)
     Q1-low SES132 (13.4%)29 (16.8%)1.45 (0.82–2.54)1.50 (0.85–2.62)1.36 (0.78–2.37)1.34 (0.75–2.40)
      Ptrend0.050.040.100.09
    Education and nSESg
     ≥ College, high nSES285 (28.9%)46 (26.6%)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     ≥ College, low nSES366 (37.0%)70 (40.5%)1.48 (0.99–2.21)1.48 (1.00–2.20)1.40 (0.94–2.09)1.45 (0.97–2.15)
     ≤ High school graduate, high nSES82 (8.3%)16 (9.3%)1.30 (0.67–2.54)1.23 (0.63–2.41)1.36 (0.70–2.65)1.27 (0.65–2.46)
     ≤ High school graduate, low nSES255 (25.8%)41 (23.7%)1.05 (0.66–1.65)1.18 (0.76–1.83)1.07 (0.70–1.64)1.12 (0.73–1.73)
    Hispanics
    Education(N = 1,642)(N = 162)
     College+251 (15.3%)20 (12.4%)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     Vocational/some college436 (26.6%)42 (25.9%)1.29 (0.76–2.21)1.34 (0.79–2.29)1.35 (0.78–2.31)1.31 (0.77–2.23)
     High school graduate349 (21.3%)32 (19.8%)1.07 (0.58–1.98)1.09 (0.59–2.01)1.12 (0.61–2.06)1.05 (0.57–1.92)
     <High school graduate606 (36.9%)68 (42.0%)1.10 (0.62–1.97)1.23 (0.70–2.15)1.23 (0.68–2.24)1.08 (0.61–1.91)
      Ptrend0.930.760.780.82
    Neighborhood SES (nSES)f
     Q5-high SES507 (30.9%)47 (29.0%)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     Q4434 (26.4%)39 (24.1%)0.86 (0.53–1.41)0.84 (0.52–1.35)0.86 (0.53–1.41)0.82 (0.51–1.33)
     Q3363 (22.1%)36 (22.2%)1.07 (0.64–1.78)1.02 (0.62–1.67)1.02 (0.60–1.71)0.93 (0.57–1.52)
     Q2240 (14.6%)30 (18.5%)1.48 (0.88–2.48)1.43 (0.86–2.37)1.38 (0.82–2.33)1.20 (0.70–2.08)
     Q1-low SES98 (6.0%)10 (6.2%)1.53 (0.77–3.02)1.50 (0.76–2.97)1.56 (0.79–3.09)1.14 (0.57–2.28)
      Ptrend0.090.110.130.47
    Education and nSESg
     ≥ College, high nSES510 (31.1%)48 (29.6%)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     ≥ College, low nSES177 (10.8%)14 (8.6%)1.05 (0.58–1.89)1.09 (0.60–1.98)1.08 (0.58–2.02)0.93 (0.50–1.73)
     ≤ High school graduate, high nSES431 (26.3%)38 (23.5%)0.78 (0.48–1.28)0.85 (0.53–1.37)0.86 (0.53–1.41)0.77 (0.48–1.25)
     ≤ High school graduate, low nSES524 (31.9%)62 (38.3%)1.23 (0.81–1.87)1.27 (0.85–1.89)1.26 (0.80–1.97)1.01 (0.65–1.55)
    Asian-Americans
    Education(N = 672)(N = 75)
     College+381 (56.7%)35 (46.7%)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     Vocational/some college176 (26.2%)18 (24.0%)1.00 (0.51–1.94)1.01 (0.52–1.98)0.86 (0.45–1.64)0.90 (0.48–1.68)
     ≤ High school graduatee115 (17.1%)22 (29.3%)1.14 (0.59–2.20)1.31 (0.69–2.48)0.98 (0.47–2.03)1.13 (0.59–2.15)
      Ptrend0.710.460.870.80
    Neighborhood SES (nSES)f
     Q5-high SES367 (54.6%)29 (38.7%)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     Q4164 (24.4%)22 (29.3%)2.44 (1.36–4.39)2.41 (1.33–4.37)2.51 (1.37–4.61)2.51 (1.40–4.49)
     Q3101 (15.0%)16 (21.3%)2.58 (1.19–5.56)2.64 (1.27–5.49)2.59 (1.28–5.22)2.51 (1.13–5.58)
     Q1, Q2-low SES40 (6.0%)8 (10.7%)3.98 (1.78–8.92)3.21 (1.20–8.63)4.07 (1.76–9.41)3.76 (1.52–9.30)
      Ptrend<0.01<0.01<0.01<0.01
    Education and nSESg
     ≥ College, high nSES466 (69.4%)39 (52.0%)1.00 (reference)1.00 (reference)1.00 (reference)1.00 (reference)
     ≥ College, low nSES91 (13.5%)14 (18.7%)2.27 (1.15–4.49)2.05 (1.01–4.16)2.09 (1.05–4.14)1.92 (0.82–4.52)
     ≤ High school graduate, high nSES65 (9.7%)12 (16.0%)1.67 (0.80–3.46)1.72 (0.85–3.46)1.38 (0.58–3.28)1.50 (0.75–3.01)
     ≤ High school graduate, low nSES50 (7.4%)10 (13.3%)2.46 (1.05–5.75)2. 74 (1.21–6.23)2.29 (0.99–5.32)2.42 (1.03–5.69)

    NOTE: Bold font refers to statistically significant associations.

    • ↵aAdjusted for age at diagnosis (continuous), year of diagnosis (continuous), study eligibility (NC-BCFR high risk, NC-BCFR sporadic, SFBCS), histology (ductal, lobular, other), histologic grade (1–4, unknown), joint ERPR status (ER−PR−, ER+, or PR+, unknown), nodal involvement (none, positive, unknown), type of surgery (none, lumpectomy, mastectomy, NOS, unknown), radiation (no, yes, unknown), chemotherapy (no, yes, unknown), first subsequent primary tumor (yes, no), second subsequent primary tumor (yes, no), days between the dates of diagnosis of study qualifying tumor and the first subsequent tumor (continuous), days between the dates of diagnosis of the first and second subsequent tumor (continuous), benign breast disease (no, yes, unknown), years since last full-term pregnancy (≤2, 2–4, 5±, unknown), prediagnosis hormonal contraception use (never, ever, unknown), prediagnosis hormone therapy use (never, past, recent, unknown) and clustering by block group, and stratified by AJCC stage (I–IV, unknown).

    • ↵bAdjusted for age at diagnosis (continuous), study eligibility (NC-BCFR high risk, NC-BCFR sporadic, SFBCS), histology (ductal, lobular, other), histologic grade (1–4, unknown), joint ERPR status (ER−PR−, ER+, or PR+, unknown), nodal involvement (none, positive, unknown), type of surgery (none, lumpectomy, mastectomy, NOS, unknown), radiation (no, yes, unknown), chemotherapy (no, yes, unknown), first subsequent primary tumor (yes, no), second subsequent primary tumor (yes, no), days between the dates of diagnosis of study qualifying tumor and the first subsequent tumor (continuous), days between the dates of diagnosis of the first and second subsequent tumor (continuous), marital status (single/never married, married, separated/divorced, widowed, unknown) and clustering by block group, and stratified by AJCC stage (I–IV, unknown).

    • ↵cAdjusted for age at diagnosis (continuous), study eligibility (NC-BCFR high risk, NC-BCFR sporadic, SFBCS), histology (ductal, lobular, other), histologic grade (1–4, unknown), joint ERPR status (ER−PR−, ER+, or PR+, unknown), nodal involvement (none, positive, unknown), type of surgery (none, lumpectomy, mastectomy, NOS, unknown), radiation (no, yes, unknown), chemotherapy (no, yes, unknown), first subsequent primary tumor (yes, no), second subsequent primary tumor (yes, no), days between the dates of diagnosis of study qualifying tumor and the first subsequent tumor (continuous), days between the dates of diagnosis of the first and second subsequent tumor (continuous), grams per day of alcohol in reference year (0,≤5, 5–9, 10–14, 15±, unknown), prediagnosis BMI (≤25, 25–29, 30±, unknown), recent recreational physical activity (0, Q1/Q2, Q3/Q4, unknown) and clustering by block group, and stratified by AJCC stage (I–IV, unknown).

    • ↵dAdjusted for age at diagnosis (continuous), study eligibility (NC-BCFR high risk, NC-BCFR sporadic, SFBCS), histology (ductal, lobular, other), histologic grade (1–4, unknown), joint ERPR status (ER−PR−, ER+, or PR+, unknown), nodal involvement (none, positive, unknown), type of surgery (none, lumpectomy, mastectomy, NOS, unknown), radiation (no, yes, unknown), chemotherapy (no, yes, unknown), first subsequent primary tumor (yes, no), second subsequent primary tumor (yes, no), days between the dates of diagnosis of study qualifying tumor and the first subsequent tumor (continuous), days between the dates of diagnosis of the first and second subsequent tumor (continuous), percent of white patients with cancer in reporting hospital (≤25%, 25–49%, 50–74%, ≥75%, unknown), percent of patients with cancer in highest SES quintile in reporting hospital (≤25%, 25–49%, 50–74%, ≥75%, unknown), and clustering by block group, and stratified by AJCC stage (I–IV, unknown).

    • ↵eEducation levels (<high school graduate and high school graduate) collapsed as ≤ high school graduate.

    • ↵fNeighborhood SES was measured using a composite measure of 7 Census indicator measures known as the Yost SES Index (29).

    • ↵gSES levels collapsed as Q1 to Q3: low SES; Q4 to Q5: high SES.

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Cancer Epidemiology Biomarkers & Prevention: 23 (5)
May 2014
Volume 23, Issue 5
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Impact of Neighborhood and Individual Socioeconomic Status on Survival after Breast Cancer Varies by Race/Ethnicity: The Neighborhood and Breast Cancer Study
Salma Shariff-Marco, Juan Yang, Esther M. John, Meera Sangaramoorthy, Andrew Hertz, Jocelyn Koo, David O. Nelson, Clayton W. Schupp, Sarah J. Shema, Myles Cockburn, William A. Satariano, Irene H. Yen, Ninez A. Ponce, Marilyn Winkleby, Theresa H.M. Keegan and Scarlett L. Gomez
Cancer Epidemiol Biomarkers Prev May 1 2014 (23) (5) 793-811; DOI: 10.1158/1055-9965.EPI-13-0924

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Impact of Neighborhood and Individual Socioeconomic Status on Survival after Breast Cancer Varies by Race/Ethnicity: The Neighborhood and Breast Cancer Study
Salma Shariff-Marco, Juan Yang, Esther M. John, Meera Sangaramoorthy, Andrew Hertz, Jocelyn Koo, David O. Nelson, Clayton W. Schupp, Sarah J. Shema, Myles Cockburn, William A. Satariano, Irene H. Yen, Ninez A. Ponce, Marilyn Winkleby, Theresa H.M. Keegan and Scarlett L. Gomez
Cancer Epidemiol Biomarkers Prev May 1 2014 (23) (5) 793-811; DOI: 10.1158/1055-9965.EPI-13-0924
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