Individual and Neighborhood Socioeconomic Status and Healthcare Resources in Relation to Black-White Breast Cancer Survival Disparities
Table 3
Cox Proportional Hazard analysis of breast cancer mortality, SEER-NLMS, 1973–2003.
Characteristics
Hazard ratio (95% CI) of breast cancer mortality
Unadjusted
Model 1 Demographicsa
Model 2 +Clinicalb
Model 3 +Countyc
Race
Black
1.53 (1.11–2.11)**
1.40 (0.99–1.97)
1.40 (0.99–1.98)
1.32 (0.73–2.41)
White (ref.)
1.00
1.00
1.00
1.00
Age
1.02 (1.01-1.02)**
1.01 (1.00–1.02)
1.01 (0.99–1.02)
1.01 (0.99–1.02)
Income/$1000
0.99 (0.99-1.00)*
0.99 (0.99-1.00)
0.99 (0.99–1.00)
0.99 (0.99–1.00)
Employed
Not in labor force
1.09 (0.87–1.38)
1.02 (0.78–1.33)
1.33 (1.01–1.74)*
1.38 (0.89–2.14)
In labor force (ref.)
1.00
1.00
1.00
1.00
Marital status
Single
1.35 (0.90–2.03)
1.10 (0.72–1.70)
1.21 (0.78–1.87)
1.16 (0.67–2.02)
Divorced/separated
1.57 (1.12–2.19)
1.43 (1.01–2.03)*
1.57 (1.09–2.25)*
1.64 (1.09–2.45)*
Widowed
1.05 (0.79–1.38)
0.95 (0.71–1.28)
1.09 (0.80–1.48)
1.09 (0.72–1.66)
Married (ref.)
1.00
1.00
1.00
1.00
Education
<High school
1.68 (1.19–2.36)**
1.44 (1.00–2.05)*
1.36 (0.95–1.94)
1.35 (0.99–1.85)
High school grad
1.43 (1.12–1.83)**
1.38 (1.08–1.78)*
1.42 (1.09–1.83)**
1.55 (1.22–1.96)**
College (ref.)
1.00
1.00
1.00
1.00
Stage of presentation
Regional
4.48 (3.23–6.22)**
3.27 (2.44–4.39)***
3.38 (2.48–4.60)***
Distant/unstaged
9.59 (6.88–13.39)**
4.18 (3.03–5.77)***
5.78 (3.06–10.93)***
In situ/local (ref.)
1.00
1.00
1.00
Surgical treatment
Nonemedical reasons
16.66 (11.28–24.59)**
8.55 (5.54–13.21)***
8.15 (3.56–18.68)***
None-non medical reasons
5.07 (3.36–7.60)**
3.72 (2.39–5.84)***
3.23 (1.56–6.68)**
Received (ref.)
1.00
1.00
1.00
Radiation treatment
None-autopsy diagnosis
1.05 (0.82–1.35)
0.87 (0.67–1.41)
0.85 (0.62–1.16)
None-refused/unknown
2.57 (1.68–3.91)**
2.10 (1.35–3.28)**
1.91 (0.95–3.86)
Received (ref.)
1.00
1.00
1.00
Rural/urban
Urban
1.12 (0.74–1.69)
1.40 (0.84–2.35)*
Rural (ref.)
1.00
1.00
dIncome disparity
Poorest
1.24 (0.96–1.61)
1.29 (0.82–2.05)
Middle
1.17 (0.86–1.59)
1.49 (1.12–1.99)**
Highest (ref.)
1.00
1.00
dEducation disparity
Poorest
1.03 (0.74–1.43)
0.55 (0.31–0.98)*
Middle
1.03 (0.77–1.39)
0.65 (0.44–0.96)*
Highest (ref.)
1.00
1.00
eFacilities
Poorest
0.76 (0.59–0.97)
1.01 (0.61–1.68)
Middle
1.00 (0.77–1.31)
1.15 (0.66–1.99)
Highest (ref.)
1.00
1.00
ePersonnel
Poorest
1.12 (0.78–1.61)
0.78 (0.40–1.51)
Middle
0.96 (0.72–1.27)
0.78 (0.49–1.24)
Highest (ref.)
1.00
1.00
Proportion non-English speaking
≥3%
0.75 (0.59–0.95)*
0.91 (0.56–1.48)
<3% (ref.)
1.00
1.00
Proportion black
≥6%
1.29 (0.98–1.68)
1.74 (1.21–2.48)**
<6% (ref.)
1.00
1.00
, **, ***; CI: confidence interval; ref: reference group.
aModel adjusting for individual demographic variables only.
bModel adjusting for clinical variables such as stage at presentation and treatment in addition to demographic variables.
cModel adjusting for county level variables including healthcare access and SES in addition to individual demographics and clinical variables.
dMeasures of SES at the county level are the ICE-Income and ICE-Education variables which were calculated and categorized into tertiles, defined as ICE-Education = (% 25+ years with college 25+ years with <9 yrs education). ICE-Income = (% with HH income > $100,0 HH in poverty).
ePersonnel and facilities, two measures of health care access were defined using principal components analysis on the count per 10,000 population of county level variables and then categorized into tertiles. Facilities: hospitals, mammography facilities; Personnel: MDs, Dos, and nurse practitioners.
