Table 6.
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 | Cases |
Breast Cancer Mortality
|
||||||
|---|---|---|---|---|---|---|---|---|
| Deaths | Base + SES+ Reproductive Factor Modela | Base + SES + Marital Status Modelb | Base + SES + Behavioral Factors Modelc | Base + SES + Hospital Characteristics Modeld | ||||
| n (%) | 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 College | 374 (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 Graduatee | 220 (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) | ||
| p-trend | 0.75 | 0.63 | 0.76 | 0.64 | ||||
| Neighborhood SES (nSES)f | ||||||||
| Q5-High SES | 671 (62.9%) | 93 (59.2%) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | ||
| Q4 | 257 (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) | ||
| Q3 | 100 (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 SES | 39 (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) | ||
| p-trend | 1.00 | 0.94 | 0.92 | 0.52 | ||||
|
| ||||||||
| Education & nSESg | ||||||||
| >=College, High SES | 759 (71.1%) | 111 (70.7%) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | ||
| >=College, Low SES | 88 (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 SES | 169 (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 SES | 51 (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 College | 430 (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 Graduate | 194 (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 Graduate | 143 (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) | ||
| p-trend | 0.25 | 0.48 | 0.36 | 0.39 | ||||
| Neighborhood SES (nSES)f | ||||||||
| Q5-High SES | 151 (15.3%) | 29 (16.8%) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | ||
| Q4 | 216 (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) | ||
| Q3 | 207 (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) | ||
| Q2 | 282 (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 SES | 132 (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) | ||
| p-trend | 0.05 | 0.04 | 0.10 | 0.09 | ||||
|
| ||||||||
| Education & nSESg | ||||||||
| >=College, High SES | 285 (28.9%) | 46 (26.6%) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | ||
| >=College, Low SES | 366 (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 SES | 82 (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 SES | 255 (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 College | 436 (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 Graduate | 349 (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 Graduate | 606 (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) | ||
| p-trend | 0.93 | 0.76 | 0.78 | 0.82 | ||||
| Neighborhood SES (nSES)f | ||||||||
| Q5-High SES | 507 (30.9%) | 47 (29.0%) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | ||
| Q4 | 434 (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) | ||
| Q3 | 363 (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) | ||
| Q2 | 240 (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 SES | 98 (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) | ||
| p-trend | 0.09 | 0.11 | 0.13 | 0.47 | ||||
|
| ||||||||
| Education & nSESg | ||||||||
| >=College, High SES | 510 (31.1%) | 48 (29.6%) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | ||
| >=College, Low SES | 177 (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 SES | 431 (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 SES | 524 (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 College | 176 (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 Graduatee | 115 (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) | ||
| p-trend | 0.71 | 0.46 | 0.87 | 0.80 | ||||
| Neighborhood SES (nSES)f | ||||||||
| Q5-High SES | 367 (54.6%) | 29 (38.7%) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | ||
| Q4 | 164 (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) | ||
| Q3 | 101 (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 SES | 40 (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) | ||
| p-trend | <0.01 | <0.01 | <0.01 | <0.01 | ||||
|
| ||||||||
| Education & nSESg | ||||||||
| >=College, High SES | 466 (69.4%) | 39 (52.0%) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | ||
| >=College, Low SES | 91 (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 SES | 65 (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 SES | 50 (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) | ||
Adjusted 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), histology (ductal, lobular, other), histological grade (1,2,3 & 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), 1st subsequent primary tumor (yes, no), 2nd subsequent primary tumor (yes, no), days between the dates of diagnosis of study qualifying tumor and the 1st subsequent tumor(continuous), days between the dates of diagnosis of the 1st and 2nd subsequent tumor (continuous), benign breast disease (no, yes, unknown), years since last full-term pregnancy (<2, 2–4, 5+, unknown), pre-diagnosis hormonal contraception use (never, ever, unknown), pre-diagnosis hormone therapy use (never, past, recent, unknown) and clustering by block group, and stratified by AJCC stage (I, II, III, IV, unknown).
Adjusted for age at diagnosis (continuous), study eligibility (Northern California site of the Breast Cancer Family Registry (NC-BCFR) high risk, NC-BCFR sporadic, SFBCS), histology (ductal, lobular, other), histological grade (1,2,3 & 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), 1st subsequent primary tumor (yes, no), 2nd subsequent primary tumor (yes, no), days between the dates of diagnosis of study qualifying tumor and the 1st subsequent tumor(continuous), days between the dates of diagnosis of the 1st and 2nd subsequent tumor (continuous), marital status (single/never married, married, separated/divorced, widowed, unknown), and clustering by block group, and stratified by AJCC stage (I, II, III, IV, unknown).
Adjusted for age at diagnosis (continuous), study eligibility (Northern California site of the Breast Cancer Family Registry (NC-BCFR) high risk, NC-BCFR sporadic, SFBCS), histology (ductal, lobular, other), histological grade (1,2,3 & 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), 1st subsequent primary tumor (yes, no), 2nd subsequent primary tumor (yes, no), days between the dates of diagnosis of study qualifying tumor and the 1st subsequent tumor(continuous), days between the dates of diagnosis of the 1st and 2nd subsequent tumor (continuous), grams per day of alcohol in reference year (0,<5, 5–9, 10–14, 15+, unknown), pre-diagnosis 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, II, III, IV, unknown).
Adjusted for age at diagnosis (continuous), study eligibility (Northern California site of the Breast Cancer Family Registry (NC-BCFR) high risk, NC-BCFR sporadic, SFBCS), histology (ductal, lobular, other), histological grade (1,2,3 & 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), 1st subsequent primary tumor (yes, no), 2nd subsequent primary tumor (yes, no), days between the dates of diagnosis of study qualifying tumor and the 1st subsequent tumor(continuous), days between the dates of diagnosis of the 1st and 2nd subsequent tumor (continuous), percent of White cancer patients in reporting hospital (<25%, 25–49%, 50–74%, ≥ 75%, unknown), percent of cancer patients 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, II, III, IV, unknown).
Education levels (<high school graduate and high school graduate) collapsed as <=high school graduate.
Neighborhood SES was measured using a composite measure of 7 Census indicator measures known as the Yost SES Index (29).
SES levels collapsed as Q1–Q3: low SES; Q4–Q5: high SES.