Racism, Residential Racial Segregation, and Breast Cancer Survival Disparities among Black, Hispanic and non-Hispanic White Women

黑人、西班牙裔和非西班牙裔白人女性之间的种族主义、居住种族隔离和乳腺癌生存差异

• 批准号: 9925056
• 负责人: Kirsten M Beyer
• 金额: $ 47.59万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-05-08 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9925056
• 关键词: Advocacy; Air Pollution; Area; Biometry; Breast Cancer survivor; Cancer Survivorship; Communities; Complement; Crime; Data; Data Collection; Databases; Development; Diagnosis; Discrimination; Disease; Education; Employment; Environment; Epidemiology; Etiology; Future; Geography; Health; Hispanics; Housing; Interdisciplinary Study; Intervention; Knowledge; Link; Louisiana; Malignant Neoplasms; Mammographic screening; Masks; Massachusetts; Measures; Mediating; Mediation; Medicare; Methods; Minnesota; Mississippi; Modeling; Not Hispanic or Latino; Outcome; Pathway interactions; Policies; Politics; Positioning Attribute; Process; Qualitative Research; Reporting; Research; Research Personnel; Resources; Staging; Suggestion; System; United States; Variant; Wisconsin; Woman; Work; breast cancer survival; cancer health disparity; care outcomes; community organizations; disparity reduction; geographic difference; health disparity; improved; innovation; interest; malignant breast neoplasm; metropolitan; mortality; novel; racial and ethnic disparities; racial bias; racial disparity; racism; screening; segregation; social; stressor

TITLE: Racism, Residential Racial Segregation, and Breast Cancer Survival Disparities among Black, Hispanic and non-Hispanic White Women ABSTRACT/SUMMARY Racial disparities in breast cancer survival are significant, with only 68% of US Black women diagnosed with breast cancer remaining alive 10 years post-diagnosis, compared to 84% of White women. However, the size of the racial disparity in breast cancer mortality varies geographically across the US, from no observable state- level disparity between Black and White women in Minnesota and Massachusetts, to a mortality rate ratio of over 1.60 in Mississippi, Louisiana, and Wisconsin. Further, although the national survival gap between Hispanics and non-Hispanic Whites is small, national numbers mask substantial variation among subpopulations of Hispanics and poorer outcomes among Hispanics in some localities. Such geographical variation suggests that disparities are not inevitable, and this variation has not been explained. Racism and racial residential segregation are widely considered to contribute to health disparities, and may partially explain geographical variation in the size of the disparity. While some studies have shown that segregation is related to poor survival, others have found that this is not always the case, and some studies highlight the case of ethnic enclaves, which may be protective. Additionally, we have recently shown that a measure of racial bias in housing is associated with breast cancer survival among Black women in the Milwaukee area. We propose to build upon our previous work to undertake a national study of segregation and breast cancer survival with three aims: (1) Construct new and existing metrics of racism and segregation at the local level for the largest US metropolitan areas, and determine (a) how measures co-vary, (b) whether segregation measures predict stressors, social resources and opportunities at the local level, and (c) whether relationships differ by metropolitan area, (2) Determine whether measures of segregation are related to breast cancer survival disparities among Black, Hispanic and Non-Hispanic White women, and whether relationships are mediated by local stressors, social resources, or opportunities, and (3) Explore the ways in which Black and Hispanic breast cancer survivors in a highly segregated metropolitan area navigate cancer survivorship in the context of segregation. The interdisciplinary research team is well-positioned to conduct this work, with expertise in breast cancer, health disparities, geography, biostatistics, epidemiology, large database analysis, mediation analysis, qualitative research, and community engaged research. Further, we have established partnerships with numerous local community organizations working directly with breast cancer survivors in the Milwaukee area through a regional community advisory board, and have drawn upon these relationships to convene an advisory board specific to this project, engaged to guide and support data collection and interpret and disseminate research findings. The successful completion of the proposed work will support the development of future multi-sectoral interventions to reduce disparities by targeting local systems and policies.

种族主义，居住种族隔离，黑人，西班牙裔之间的乳腺癌生存差异 非西班牙裔白色妇女 摘要/总结 乳腺癌生存率的种族差异很大，只有68%的美国黑人女性被诊断为乳腺癌。 乳腺癌患者在诊断后10年内仍然存活，而白色女性的这一比例为84%。然而，尺寸 乳腺癌死亡率的种族差异在美国各地各不相同，从没有观察到的州- 明尼苏达州和马萨诸塞州黑人和白色妇女之间的水平差距，死亡率比率为 在密西西比、路易斯安那和威斯康星州超过1.60。此外，虽然国家之间的生存差距 西班牙裔和非西班牙裔白人人数很少，全国人数掩盖了 拉美裔人的亚群和拉美裔人在一些地方较差的结果。这样的地理 差异表明差异并非不可避免，而这种差异尚未得到解释。种族主义和 种族居住隔离被广泛认为是造成健康差异的原因， 差距大小的地理差异。虽然一些研究表明，隔离与 生存差，其他人发现，这并不总是如此，一些研究强调的情况下，种族 飞地，这可能是保护。此外，我们最近表明，种族偏见的措施， 住房与密尔沃基地区黑人妇女的乳腺癌存活率有关。我们建议 在我们以前的工作的基础上，进行一项全国性的隔离和乳腺癌生存的研究， 目标：（1）在地方一级为美国最大的种族主义和种族隔离建立新的和现有的指标 大都市地区，并确定（a）措施如何共同变化，（B）隔离措施是否预测 地方一级的压力、社会资源和机会，以及（c）关系是否因 大都市区，（2）确定隔离措施是否与乳腺癌生存有关 黑人，西班牙裔和非西班牙裔白色妇女之间的差异，以及关系是否由 当地的压力源，社会资源，或机会，（3）探索黑人和西班牙裔乳房的方式， 癌症幸存者在高度隔离的大都市地区导航癌症生存的背景下， 种族隔离跨学科的研究团队是很好的定位进行这项工作，具有专业知识， 乳腺癌，健康差距，地理，生物统计学，流行病学，大型数据库分析，调解 分析，定性研究和社区参与的研究。此外，我们还建立了伙伴关系， 在密尔沃基，许多当地社区组织直接与乳腺癌幸存者合作， 通过一个区域社区咨询委员会，并利用这些关系， 专门针对本项目的咨询委员会，负责指导和支持数据收集和解释， 传播研究成果。拟议工作的顺利完成将支持 今后多部门的干预措施，通过针对地方系统和政策来减少不平等。