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Social determinants of breast cancer mortality are not spatially stationary in the United States, according to a cross-sectional study published in JAMA Network Open.
Determinants of breast cancer mortality are generally understood with established successful interventions and prevention strategies. However, geographic disparities in breast cancer mortality remain.
Investigators from George Mason University sourced data for this study from the Surveillance, Epidemiology, and End Results (SEER) database to evaluate location-based determinants of breast cancer mortality in the US. Age-adjusted mortality rates between 2015 and 2019 were evaluated among women in 2176 counties.
In a multiple linear regression analysis, food environment index (b, −1.69), mammography access (b, −1.07), primary health care access (b, −1.06), smoking (b, −0.75), exercise opportunities (b, −0.59), mental health care access (b, −0.48), segregation (b, −0.47), and transit access (b, −0.31) were negative determinants of breast cancer mortality and obesity (b, 0.72), grocery stores per capita (b, 0.33), and mean radiance (b, 0.27) were positive determinants of breast cancer mortality (all P ≤.03).
In a geographically weighted regression analysis, obesity and access to mammography were significant determinants of breast cancer mortality in 100% of counties. The next-best determinants for breast cancer mortality were transit access (83.0%), food environment index (80.3%), proportion of the population with disability (45.0%), mean radiance (42.4%), and primary care access (40.6%).
These 2 models did not come to consensus findings for all determinants, however, both models did not identify unemployment, long commute, income inequality, hospital number, and proportion of natural land as relevant mortality determinants.
These findings may have been biased, as variables were measured at the county level, not at the person level.
The results of this study highlighted regional-specific trends in breast cancer mortality determinants. The study authors concluded, “Untangling these complex relationships requires innovative and multidisciplinary approaches able to tie place-specific factors with disease-related outcomes.”
Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Anderson T, Herrera D, Mireku F, et al. Geographical variation in social determinants of female breast cancer mortality across US counties. JAMA Netw Open. 2023;6(9):e2333618. doi:10.1001/jamanetworkopen.2023.33618
