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

标题：种族主义、居住性种族隔离和黑人、西班牙裔之间的乳腺癌存活率差异 和非西班牙裔白人女性 摘要/摘要 乳腺癌存活率的种族差异很大，只有68%的美国黑人女性被诊断出患有乳腺癌 乳腺癌在确诊后10年仍然存活，相比之下，白人女性的这一比例为84%。然而，其大小 美国各地乳腺癌死亡率的种族差异在地理上有所不同，从没有观察到的状态- 明尼苏达州和马萨诸塞州黑人和白人女性之间的水平差距，死亡率比 密西西比州、路易斯安那州和威斯康星州超过1.60。此外，尽管国家之间的生存差距 拉美裔和非拉美裔白人很少，全国人口数量掩盖了他们之间的巨大差异 在一些地区，拉美裔美国人的亚群和西班牙裔美国人的结果较差。这样的地理位置 差异表明，差异并不是不可避免的，这种差异也没有得到解释。种族主义和 种族隔离被广泛认为是造成健康差距的原因，这可能在一定程度上解释了 地域差异的大小差距。虽然一些研究表明，种族隔离与 生存不佳，其他人发现情况并不总是如此，一些研究强调了种族问题 飞地，这可能是保护性的。此外，我们最近表明，种族偏见的一种衡量标准 住房与密尔沃基地区黑人女性的乳腺癌存活率有关。我们建议 在我们先前工作的基础上，开展了一项关于种族隔离和乳腺癌生存率的全国性研究， 目标：(1)为美国最大的地方建立新的和现有的种族主义和种族隔离指标 大都会地区，并决定(A)措施如何共同变化，(B)隔离措施是否可以预测 地方一级的压力源、社会资源和机会，以及(C)关系是否因 大都会地区，(2)确定隔离措施是否与乳腺癌生存率有关 黑人、西班牙裔和非西班牙裔白人女性之间的差异，以及关系是否由 当地的压力源、社会资源或机会，以及(3)探索黑人和西班牙裔乳房的方式 在高度隔离的大都市地区，癌症幸存者在 种族隔离。跨学科研究团队有能力开展这项工作，具备以下方面的专长 乳腺癌，健康差异，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研究。此外，我们还建立了合作伙伴关系 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，并利用这些关系召开了 专门针对该项目的咨询委员会，负责指导和支持数据收集和解释以及 传播研究成果。拟议工作的成功完成将为发展提供支持 未来的多部门干预措施，以当地系统和政策为目标，减少差距。

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.