Social Determinants of Black-White Disparities in Breast Cancer Mortality: A Review

Department of Medical Humanities and Social Sciences, College of Medicine, Florida State University, 1115 West Call Street, Tallahassee, FL 32306-4300, USA.
Cancer Epidemiology Biomarkers & Prevention (Impact Factor: 4.32). 12/2008; 17(11):2913-23. DOI: 10.1158/1055-9965.EPI-07-0633
Source: PubMed

ABSTRACT Despite the recent decline in breast cancer mortality, African American women continue to die from breast cancer at higher rates than do White women. Beyond the fact that breast cancer tends to be a more biologically aggressive disease in African American than in White women, this disparity in breast cancer mortality also reflects social barriers that disproportionately affect African American women. These barriers hinder cancer prevention and control efforts and modify the biological expression of disease. The present review focuses on delineating social, economic, and cultural factors that are potentially responsible for Black-White disparities in breast cancer mortality. This review was guided by the social determinants of health disparities model, a model that identifies barriers associated with poverty, culture, and social injustice as major causes of health disparities. These barriers, in concert with genetic, biological, and environmental factors, can promote differential outcomes for African American and White women along the entire breast cancer continuum, from screening and early detection to treatment and survival. Barriers related to poverty include lack of a primary care physician, inadequate health insurance, and poor access to health care. Barriers related to culture include perceived invulnerability, folk beliefs, and a general mistrust of the health care system. Barriers related to social injustice include racial profiling and discrimination. Many of these barriers are potentially modifiable. Thus, in addition to biomedical advancements, future efforts to reduce disparities in breast cancer mortality should address social barriers that perpetuate disparities among African American and White women in the United States.

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    • "Despite the health implications of racial and gender disparities in utilisation, most research in this area focuses on acute physical or mental health services and service utilisation among the elderly (Ojeda and Bergstresser 2008, Shenson et al. 2012, Williams and Mohammed 2009). In addition, with the exception of studies examining end-of-life care and cancer treatment decisions, few existing utilisation studies examine the role of factors like religiosity, cultural attitudes and experiences, and social support that may be particularly relevant to African American women (Gerend and Pai 2008, Johnson et al. 2005). Importantly, the findings of this extant research cannot be expected to translate to preventative care utilisation. "
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    ABSTRACT: Research suggests that African Americans are less likely to utilise preventative care services than Americans of European descent, and that these patterns may contribute to racial health disparities in the United States. Despite the persistence of inequalities in preventative care utilisation, culturally relevant factors influencing the use of these gateway health services have been understudied among marginalised groups. Using a stratified sample of 205 low-income African American women, this research examines the predictors of receiving a physical exam, with a particular emphasis on how differing levels of social support from friend and family networks and experiences of racial discrimination and cultural mistrust shape utilisation. The findings underscore the importance of traditional predictors of utilisation, including insurance status and having a usual physician. However, they also indicate that supportive ties to friendship networks are associated with higher predicted rates of having an annual physical exam, while social support from family and sentiments of cultural mistrust are associated with lower rates of utilisation. Broadly, the findings indicate that even as traditional predictors of help-seeking become less relevant, it will be critical to explore how variations in discrimination experiences and social relationships across marginalised groups drive patterns of preventative care utilisation.
    Sociology of Health & Illness 04/2014; 36(7). DOI:10.1111/1467-9566.12141 · 1.88 Impact Factor
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    • "Studies that assessed the role of county level healthcare access on late stage diagnosis of cancer found that women residing in counties with fewer physicians [33] and poor access to mammography facilities [32] were more likely to have late stage cancer diagnosis. Other studies have suggested that important predictors of mammography use are having a primary care physician, travel times, and public transportation hassles [55] [56] [57] [58] [59] [60] [61] [62] [63] [64]. These are all factors which may be compounded if there are inadequate healthcare facilities and personnel within a county. "
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    ABSTRACT: Background. Breast cancer survival has improved significantly in the US in the past 10-15 years. However, disparities exist in breast cancer survival between black and white women. Purpose. To investigate the effect of county healthcare resources and SES as well as individual SES status on breast cancer survival disparities between black and white women. Methods. Data from 1,796 breast cancer cases were obtained from the Surveillance Epidemiology and End Results and the National Longitudinal Mortality Study dataset. Cox Proportional Hazards models were constructed accounting for clustering within counties. Three sequential Cox models were fit for each outcome including demographic variables; demographic and clinical variables; and finally demographic, clinical, and county-level variables. Results. In unadjusted analysis, black women had a 53% higher likelihood of dying of breast cancer and 32% higher likelihood of dying of any cause (P < 0.05) compared with white women. Adjusting for demographic variables explained away the effect of race on breast cancer survival (HR, 1.40; 95% CI, 0.99-1.97), but not on all-cause mortality. The racial difference in all-cause survival disappeared only after adjusting for county-level variables (HR, 1.27; CI, 0.95-1.71). Conclusions. Improving equitable access to healthcare for all women in the US may help eliminate survival disparities between racial and socioeconomic groups.
    Journal of Cancer Epidemiology 02/2013; 2013(1):490472. DOI:10.1155/2013/490472
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    • "The SDH provide a unique perspective to conceptualize health and well-being as documented in Gerend and Pai (2008) review on Black–White disparities in breast cancer mortality. The review focused on poverty, cultural, and social injustice as determinants of breast cancer mortality (Gerend & Pai, 2008). The review reported that these factors, along with biological, genetic and environmental factors, led to differences in levels of screening, detection, treatment, and survival for breast cancer. "
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    ABSTRACT: The recent decline in the breast cancer mortality rate can be attributed to intensive screening and early detection efforts. However, studies have documented a decline in self-reported recent mammography use and interventions to enhance mammography utilization have yielded modest improvements. To address the root causes of breast cancer disparities and improve mammography use, interventions need to address multiple layers of patient, provider, and health system factors. Using community-based participatory research principles, we sought to learn from women receiving care through urban primary care practices about issues surrounding mammography screening and strategies to increase screening. We conducted five focus groups among 41 eligible women who were predominantly African American, recruited using nonprobability purposive sampling methods from urban community health centers in Baltimore, Maryland. Data are reported from three focus groups (n = 28) that provided usable data. We used the social determinants of health perspective to conduct a qualitative content analysis and interpretation of the data. Major obstacles to obtaining a screening mammogram were individual-level (i.e., pain from the procedure) and structural-level factors (i.e., cost, geography, convenience). Strategies to overcome obstacles could include the creation of structural mechanisms whereby women can receive a host of services during one visit to a healthcare professional's office. Important promoters of screening behavior included social-level factors such as social support, hope, and positive treatment outcomes. The social determinants of health perspective provided a unique perspective to frame barriers and promoters of mammography utilization and insights to develop interventions aimed at improving cancer control among women receiving care at urban primary care health centers.
    Women s Health Issues 07/2012; 22(5):e429-38. DOI:10.1016/j.whi.2012.06.004 · 1.61 Impact Factor
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