||5R01CA214805-03 Interpret this number
||Medical College Of Wisconsin
||Racism, Residential Racial Segregation, and Breast Cancer Survival Disparities Among Black, Hispanic and Non-Hispanic White Women
TITLE: Racism, Residential Racial Segregation, and Breast Cancer Survival Disparities among Black, Hispanic
and non-Hispanic White Women
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.
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