Neighborhood disinvestment predicts shorter cancer survival time among Black women diagnosed with invasive breast cancer.

Abstract

Background: Observed neighborhood disinvestment is a chronic social determinant that is understudied in relation to cancer outcomes. This study investigated associations between neighborhood disinvestment, stage at diagnosis, and breast cancer-specific survival time.

Methods: Individual-level data included 844 women, diagnosed 2013-2019, from the Women's Circle of Health Follow-up Study, a population-based cohort of breast cancer survivors self-identifying as Black or African American. Neighborhood disinvestment was from a virtual audit of 6 indicators - garbage, graffiti, dumpsters, building conditions, yard conditions, abandoned buildings - within 14,671 Google Streetview streetscapes estimated at residential addresses using Universal Kriging. We fit accelerated failure time models of breast cancer-specific survival (BCSS) time as functions of neighborhood disinvestment by stage, adjusted for covariates (sociodemographic, lifestyle, tumor and treatment-related factors). Participants not experiencing an event at the end of follow-up (August 13, 2023) were right-censored.

Results: With median follow-up time of 89 months, there were 91 breast cancer-specific deaths. Disinvestment and stage statistically interacted (p < 0.01). For stage III and stage II diagnoses, BCSS time decreased by 27% (95% CI: 1%, 48%) and 37% (95% CI: 5%, 58%), respectively, with each standard deviation increase in disinvestment after adjustment for covariates. There was little evidence of associations between disinvestment and survival time among stages I and IV.

Conclusions: The tumor stage-dependent association between greater neighborhood disinvestment and shorter survival time could reflect chronic stress exposures suspected to adversely accumulate over time.

Impact: Neighborhood disinvestment might be an important, independent marker of social disadvantage impacting breast cancer survival.