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[ Recorded presentation ] Recorded presentation

Enriching the theoretical basis for understanding black-white disparities in US breast cancer mortality

Robert S. Levine1, Barbara Kilbourne2, Shanita Williams-Brown1, Lee Caplan, PhD3, Baqar Husaini, PhD4, and George Rust1. (1) National Center for Primary Care, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA 33010, 404-756-8821, rlevine@msm.edu, (2) Center for Health Research, Tennessee State University, 3200 John A. Merritt Blvd, Nashville, TN 37209, (3) Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA 30310, (4) Center for Health Research, Tennesse State University, 3500 John Merritt Boulevard, Nashville, TN 37209

We performed transgeographic, anomalous community analyses of US breast cancer deaths (15,553 black; 58,061 white; 180 counties; 1999-2002). These included 72% of US black deaths and 48% of US white deaths. Communities with unusually low and unusually high overall age-adjusted black breast cancer mortality rates for women ages 35-85+ were identified with jackknife residuals after accounting for county-level percent black women 25+ without high school graduation, percent blacks with yearly income below poverty, black per capita income, Gini coefficient, and black:white poverty rate ratio. After adjustment for anomalous county characteristics, including protective effects of both percent urban population (p<0.001) and percent blacks ages 18-64 years speaking little/no English (p=0.004), socioeconomic factors did not significantly predict age-adjusted breast cancer mortality among black women 35-85+ years of age. Age-adjusted, age-specific comparisons for persons of Medicare age (65-85+) in anomalous counties did not alter conclusions. Temporal analysis of overall and age-specific black-white cancer mortality confirmed that counties anomalous in 1999-2002 had consistent histories of black:white mortality over time. These analyses show that disparities in breast cancer are not inevitable. The results challenge socioeconomic explanations of black-white disparities in breast cancer mortality and offer an alternative to SEER (Surveillance Epidemiology End Results)-based results, which may not reflect black-white racial disparities in non-SEER communities.

Learning Objectives: At the conclusion of this presentation attendees will be able to