The association of neighborhood context with health outcomes among ethnic minority breast cancer survivors

Chenkai Wu, Kimlin Tam Ashing, Veronica C. Jones, Lisa Barcelo

While individual-level determinants of health, such as education and income, have been well documented among breast cancer survivors, little is known about the role of neighborhood context on survivorship outcomes among this population. The present study examined the association of neighborhood stress with multiple health outcomes among ethnic minority breast cancer survivors (BCS). A mixed-methods approach was used to recruit 320 African-American and Hispanic BCS who were 26-89 years and lived in metropolitan Los Angeles, CA. Neighborhood stress was assessed by six items taken from the Life Stress Scale. Health outcomes included (1) self-rated health, measured by the Short-Form-36 Health Survey, (2) number of comorbidities (0-14), (3) depressive symptoms, assessed by the Center for Epidemiological Studies-Depression scale, and (4) psychological difficulties. Greater neighborhood stress was significantly associated with poorer self-reported health (adjusted β = -.22, 95% confidence interval [CI] -.40, -.05), greater number of comorbidities (adjusted risk ratio = .19, 95% CI .07, .30), more depressive symptoms (adjusted β = .10, 95% CI .06, .15), and a higher likelihood of psychological difficulties (adjusted odds ratio = 2.28, 95% CI 1.51, 3.45) among ethnic minority BCS. These findings underscored the importance of taking neighborhood context into account in examining the determinants of health, survivorship, and quality of life outcomes among cancer patients. Our findings may inform population health, health services, and interventions addressing neighborhood and individual-level factors to promote post treatment health and survivorship outcomes as well as to identify high-risk patients, especially among medically vulnerable communities.