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 (BCSS) time.

Methods: Individual-level data included 844 women, diagnosed 2013 to 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 six indicators-garbage, graffiti, dumpsters, building conditions, yard conditions, and abandoned buildings-within 14,671 Google Street View streetscapes estimated at residential addresses using Universal Kriging. We fit accelerated failure time models of BCSS time as functions of neighborhood disinvestment by stage, adjusted for covariates (sociodemographic, lifestyle, and tumor- and treatment-related factors). Participants not experiencing an event at the end of follow-up (August 13, 2023) were right-censored.

Results: With a 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% confidence interval, 1%, 48%) and 37% (95% confidence interval, 5%, 58%), respectively, with each SD 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.