Associations of neighborhood SES, neighborhood obesogenic factors, and risk of invasive breast cancer and hormone receptor–positive subtype by race/ethnicity, postmenopausal women residing in California at baseline (n = 48,247), MEC, 1993–2010
| All women(n = 48,247) | African American(n = 16,703) | Japanese American (n = 5,063) | Latino (n = 18,752) | White (n = 7,729) | |
|---|---|---|---|---|---|
| Neighborhood measure | HRa (95% Cl) | HRa (95% Cl) | HRa (95% Cl) | HRa (95% Cl) | HRa (95%Cl) |
| Overall | |||||
| Neighborhood SESb | |||||
| Quintile 5: high | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Quintile 4 | 0.92 (0.79–1.07) | 0.88 (0.61–1.27) | 0.88 (0.63–1.21) | 0.95 (0.71–1.27) | 1.01 (0.80–1.28) |
| Quintile 3 | 0.88 (0.76–1.03) | 1.12 (0.79–1.58) | 0.88 (0.63–1.25) | 0.78 (0.59–1.04) | 0.81 (0.61–1.07) |
| Quintile 2 | 0.89 (0.76–1.05) | 1.03 (0.73–1.46) | 0.73 (0.44–1.20) | 0.83 (0.62–1.11) | 0.89 (0.63–1.25) |
| Quintile 1: low | 0.79 (0.66–0.95) | 0.94 (0.65–1.36) | 1.73 (0.86–3.48) | 0.60 (0.43–0.85) | 0.80 (0.50–1.29) |
| Ptrendc | 0.02 | 0.95 | 0.83 | 0.01 | 0.19 |
| Urban environmentd | |||||
| Quintile 1: low | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Quintile 2 | 1.08 (0.95–1.23) | 1.03 (0.80–1.34) | 0.96 (0.70–1.34) | 1.03 (0.82–1.28) | 1.36 (1.07–1.73) |
| Quintile 3 | 1.03 (0.89–1.18) | 1.13 (0.88–1.47) | 0.95 (0.65–1.39) | 0.97 (0.76–1.24) | 1.07 (0.8–1.44) |
| Quintile 4 | 1.00 (0.86–1.15) | 1.06 (0.82–1.37) | 0.66 (0.41–1.08) | 0.94 (0.72–1.22) | 1.24 (0.91–1.69) |
| Quintile 5: high | 1.02 (0.87–1.20) | 1.10 (0.84–1.45) | 0.49 (0.26–0.90) | 1.07 (0.80–1.42) | 1.13 (0.76–1.70) |
| Ptrendc | 0.87 | 0.56 | 0.03 | 0.98 | 0.45 |
| Unhealthy foode | |||||
| None | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Some | 0.96 (0.84–1.09) | 1.03 (0.82–1.28) | 0.85 (0.58–1.26) | 0.93 (0.74–1.17) | 0.93 (0.69–1.25) |
| More | 1.10 (1.00–1.21) | 1.15 (0.97–1.35) | 1.08 (0.82–1.42) | 1.06 (0.89–1.27) | 1.04 (0.84–1.29) |
| Ptrendc | 0.07 | 0.11 | 0.65 | 0.55 | 0.79 |
| Mixed-land developmentf | |||||
| Quintile 5: high | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Quintile 4 | 1.07 (0.92–1.25) | 1.16 (0.84–1.59) | 1.08 (0.76–1.56) | 1.38 (1.04–1.83) | 0.81 (0.61–1.09) |
| Quintile 3 | 1.02 (0.88–1.19) | 1.16 (0.86–1.56) | 1.00 (0.66–1.51) | 1.29 (0.96–1.73) | 0.76 (0.57–1.01) |
| Quintile 2 | 1.02 (0.88–1.18) | 1.19 (0.89–1.58) | 0.96 (0.66–1.41) | 1.15 (0.86–1.53) | 0.88 (0.67–1.14) |
| Quintile 1: low | 1.11 (0.95–1.29) | 1.24 (0.93–1.66) | 0.78 (0.5–1.22) | 1.46 (1.10–1.93) | 0.87 (0.64–1.18) |
| Ptrendc | 0.36 | 0.18 | 0.24 | 0.10 | 0.49 |
| Parkg | |||||
| Some | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| None | 1.03 (0.92–1.15) | 0.93 (0.75–1.15) | 1.05 (0.78–1.42) | 1.00 (0.83–1.21) | 1.12 (0.88–1.44) |
| Ptrendc | 0.66 | 0.52 | 0.76 | 0.97 | 0.36 |
| ER+/PR+ subtype | |||||
| Neighborhood SESb | |||||
| Quintile 5: high | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Quintile 4 | 0.89 (0.74–1.06) | 0.85 (0.53–1.38) | 0.82 (0.55–1.21) | 0.87 (0.61–1.25) | 0.99 (0.76–1.29) |
| Quintile 3 | 0.82 (0.68–0.98) | 1.05 (0.65–1.68) | 0.84 (0.57–1.26) | 0.65 (0.45–0.93) | 0.75 (0.54–1.03) |
| Quintile 2 | 0.81 (0.67–0.99) | 0.99 (0.62–1.59) | 0.44 (0.23–0.86) | 0.68 (0.47–0.99) | 0.88 (0.59–1.30) |
| Quintile 1: low | 0.73 (0.58–0.92) | 0.92 (0.56–1.53) | 1.20 (0.54–2.66) | 0.52 (0.34–0.80) | 0.77 (0.45–1.31) |
| Ptrendc | 0.01 | 0.97 | 0.20 | <0.01 | 0.18 |
| Urband | |||||
| Quintile 1: low | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Quintile 2 | 1.20 (1.03–1.39) | 1.11 (0.81–1.54) | 1.20 (0.83–1.73) | 1.15 (0.88–1.51) | 1.43 (1.09–1.88) |
| Quintile 3 | 1.12 (0.95–1.33) | 1.26 (0.92–1.75) | 0.97 (0.60–1.56) | 1.12 (0.84–1.50) | 1.20 (0.86–1.69) |
| Quintile 4 | 1.04 (0.86–1.24) | 1.19 (0.85–1.65) | 0.82 (0.47–1.42) | 0.86 (0.61–1.20) | 1.32 (0.91–1.91) |
| Quintile 5: high | 1.06 (0.87–1.29) | 1.27 (0.91–1.79) | 0.55 (0.27–1.09) | 1.04 (0.73–1.49) | 1.09 (0.69–1.72) |
| Ptrendc | 0.96 | 0.22 | 0.14 | 0.66 | 0.41 |
| Unhealthy foode | |||||
| None | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Some | 0.95 (0.81–1.12) | 1.02 (0.77–1.34) | 0.94 (0.60–1.47) | 0.96 (0.73–1.28) | 0.86 (0.60–1.23) |
| More | 1.09 (0.97–1.23) | 1.05 (0.86–1.3) | 1.14 (0.82–1.59) | 1.07 (0.86–1.34) | 1.08 (0.84–1.38) |
| Ptrendc | 0.19 | 0.63 | 0.47 | 0.57 | 0.61 |
| Mixed-land developmentf | |||||
| Quintile 5: high | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Quintile 4 | 1.07 (0.90–1.27) | 1.18 (0.82–1.71) | 1.13 (0.72–1.76) | 1.50 (1.04–2.16) | 0.75 (0.55–1.03) |
| Quintile 3 | 1.00 (0.83–1.20) | 1.07 (0.75–1.5) | 1.18 (0.71–1.96) | 1.37 (0.94–2.00) | 0.67 (0.48–0.94) |
| Quintile 2 | 0.98 (0.82–1.17) | 0.96 (0.68–1.35) | 1.12 (0.70–1.78) | 1.29 (0.89–1.87) | 0.84 (0.62–1.15) |
| Quintile 1: low | 1.04 (0.87–1.25) | 1.03 (0.74–1.44) | 0.95 (0.56–1.61) | 1.49 (1.02–2.16) | 0.85 (0.60–1.19) |
| Ptrendc | 0.97 | 0.57 | 0.94 | 0.20 | 0.47 |
| Parkg | |||||
| Some | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| None | 1.06 (0.93–1.22) | 1.00 (0.77–1.3) | 1.14 (0.79–1.64) | 1.07 (0.84–1.36) | 1.10 (0.82–1.47) |
| Ptrendc | 0.39 | 1.00 | 0.50 | 0.57 | 0.55 |
NOTE: Values in bold represent P < 0.05.
↵aModels [invasive breast cancer overall and hormone receptor–positive (ER+/PR+) subtype] adjusted for age at entry, clustering effect of block group, race/ethnicity for all women, risk factors (family history of breast cancer, age at menarche, age at first live birth, number of children, hormone replacement therapy, ever had mammography, alcohol use, physical activity, education), baseline BMI and adult weight change, neighborhood SES, and all neighborhood obesogenic factors in table.
↵bComposite measure of 7 indicator variables for U.S. census block groups (Liu education index, proportion with a blue collar job, proportion older than age 16 in the workforce without a job, median household income, percent below 200% of the poverty line, median rent, median house value); categories based on distribution for block groups in Los Angeles County.
↵cTrend analysis excluding underweight and missing values. Trend variable was assigned ordinal value (i.e., 1, 2, 3) corresponding to categories.
↵dComposite measure of high population density, low commute by car, high traffic density, high street connectivity.
↵eComposite measure of high number of fast food restaurants and unhealthy retail food outlets. Unhealthy food environment index was categorized into none (no fast food restaurant and no unhealthy food outlet/minimal factor index value), some (factor index value greater than minimal and less than the median of non-minimal values), more (factor index value greater than or equal to the median of non-minimal values).
↵fComposite measure of high number of businesses and high number of recreational facilities.
↵gNumber of parks categorized into none (no park/minimal factor index value) and any (≥1 parks/factor index value greater than minimal).