Table 5.
Association of individual and neighborhood SES with breast cancer-specific mortality by race/ethnicity: Hazard Ratios (HRs) with 95% Confidence Intervals, San Francisco Bay Area, 1995–2002 (with follow-up through 2009)
| SES Variables | Non-Hispanic White | African-American | Hispanic | Asian-American | ||||
|---|---|---|---|---|---|---|---|---|
|
| ||||||||
| Base Modela | Base + Education + SES Modelb | Base Modela | Base + Education + SES Modelb | Base Modela | Base + Education + SES Modelb | Base Modela | Base + Education + SES Modelb | |
| HR (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 College | 0.87 (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 Degreec | 1.15 (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 Degree | 0.97 (0.59–1.60) | 0.83 (0.49–1.40) | 1.37 (0.82–2.27) | 1.22 (0.70–2.13) | ||||
| p-trend | 0.70 | 0.74 | 0.61 | 0.31 | 0.43 | 0.86 | 0.04 | 0.51 |
|
| ||||||||
| Neighborhood SESe | ||||||||
| Q5-High SES | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
| Q4 | 1.12 (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) |
| Q3 | 1.02 (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) |
| Q2d | 1.08 (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 SES | 1.20 (0.71–2.02) | 1.42 (0.81–2.47) | 1.48 (0.78–2.84) | 1.47 (0.74–2.91) | ||||
| p-trend | 0.75 | 0.80 | 0.17 | 0.10 | 0.10 | 0.14 | 0.01 | 0.01 |
|
| ||||||||
| Education & nSESf | ||||||||
| ≥ Some College, High SES | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | ||||
| ≥ Some College, Low SES | 0.78 (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 SES | 1.09 (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 SES | 1.52 (0.82–2.82) | 1.11 (0.72–1.70) | 1.24 (0.83–1.86) | 2.82 (1.29–6.14) | ||||
Adjusted 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), histological grade (1,2,3 & 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, II, III, IV, unknown).
Adjusted 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, II, III, IV, unknown).
Education levels (<high school graduate and high school graduate) collapsed as <=high school graduate for non-Hispanic whites and Asian-Americans due to small sample sizes.
Neighborhood SES quintiles 1 & 2 were collapsed for non-Hispanic Whites and Asian-Americans due to small sample sizes.
Neighborhood SES was measured using a composite measure of 7 Census indicator measures the YOST SES Index (29).
HS, high school. Education levels (<high school graduate and high school graduate) collapsed as <=high school graduate. Neighborhood SES levels collapsed as Q1–Q3:low SES; Q4–Q5: high SES.