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 (ERPR, 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 (ERPR, 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 (ERPR, 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 (ERPR, 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.