Maria C. Mejia de Grubb, MD, MPH; Barbara Kilbourne, PhD; Courtney Kihlberg, MD, MSPH; and Robert Levine, MD. Department of Family and Community Medicine Meharry Medical College Nashville, TN October 30, 2012

 The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: “No relationships to disclose”

 Breast cancer is the leading cause of cancer death among Hispanic women.  Hispanic women have a 20 % greater risk of dying from breast cancer than non-Hispanic whites once a diagnosis is made even though incidence and mortality are lower.  Several factors might contribute to variations of breast cancer mortality by place.

 Describe demographic and geographic variations in Hispanic mortality from malignant neoplasm of the breast among US women ages and years.

 Age-adjusted (Year 2000 standard) mortality rates and 95% confidence intervals were obtained from the Compressed Mortality File as presented on the public US Centers for Disease Control and Prevention WONDER (Wide-ranging Online Data for Epidemiologic Research) internet website.  ICD-10 code C50 (Malignant neoplasm of the breast)  All analyses were performed using SAS, v9.23  OLS regression models with dependent variable= age adjusted mortality rates (35-64 and years), and independent variables % Hispanics ≥25 years = annual income below poverty, not high school graduates, and renters.

Results

Age Group Hispanic Age- Adjusted Rate Non- Hispanic Age- Adjusted Rate Hispanic: Non- Hispanic MRR* Years AI/AN 4.7 (3.3 – 6.4) AI/AN 29.6 (28.1 – 31.1) 0.16 AA 13.3 (11.9 – 14.8) AA 64.3 (63.8 – 64.8) 0.21 API 21.4 (17.4 – 25.4) API 23.5 (23 – 24) 0.91 W 30.7 (30.3 – 31.2) W 47.5 (47.3 – 47.6) 0.65 Key: AA = Black or African American; AI/AN = American Indian or Alaska Native; API = Asian or Pacific Islander; W = White. *MMR= Hispanic: Non-Hispanic Mortality Rate Ratio.

Age GroupHispanic Age- Adjusted Rate Non- Hispanic Age- Adjusted Rate Hispanic: Non-Hispanic MMR* Years AI/AN 3.2 (2.1 – 4.5) AI/AN 17.6 (16.5 – 18.8) 0.18 AA 7.9 (6.8 – 9) AA 43.6 (16.5 – 44.1) 0.18 API 11.4 (8.9 – 14.4) API 17 (16.6 – 17.5) 0.67 W 19.7 (19.3 – 20.1) W 26.6 (26.5 – 26.8) Years AI/AN 9.4 (5.1 – 15.7) AI/AN 66.2 (61.3 – 71.1) 0.14 AA 29.9 (25.1 – 34.8) AA (125.6 – 128.6) 0.26 API 51.6 (38.7 – 67.5) API 43.3 (41.7 – 44.9) 1.19 W 64.3 (62.9 – 65.7) W (110.5 – 111.4) 0.58

Age group Census Region Hispanic Age Adjusted Rate Non- Hispanic Age Adjusted Rate Hispanic: Non- Hispanic MMR* years Northeast AA7.5AA W21W Midwest AA8.3AA W15.8W South API9.3API AA11.7AA W19.9W West AI/AN4.6AI/AN API13.9API AA3.5AA W20.2W Key: AA=Black or African American; AI/AN= American Indian or Alaskan Native; API= Asian or Pacific Islander; W=White. Census Region 1: Northeast; Census Region 2: Midwest; Census Region 3: South; Census Region 4: West. Absence of racial groups reflects lack of sufficient data to meet standards of confidentiality.

Age group Census Region Hispanic Age Adjusted Rate Non- Hispanic Age Adjusted Rate Hispanic: Non- Hispanic MMR* years Northeast AA27.6AA W67.8W Midwest AA43AA W48.6W South AA36.7AA W66.9W West API71.7API AA23.4AA W63.9W Key: AA=Black or African American; AI/AN= American Indian or Alaska Native; API= Asian or Pacific Islander; W=White. Census Region 1: Northeast; Census Region 2: Midwest; Census Region 3: South; Census Region 4: West. Absence of racial groups reflects lack of sufficient data to meet standards of confidentiality.

Percent Hispanic Population Age –Adjusted Breast Cancer Deaths for 100,000 Population

Percent Hispanic Population

Hispanic White y/o VariableParameter Estimatep value Poverty %34.71< Education % Renters % Hispanic White y/o VariableParameter Estimatep value Poverty % Education % Renters % Poverty %= percentage of Hispanics living in poverty, Education %= percentage of Hispanics with less than a high school education Renters %= percentage of Hispanics that are renters.

Age Group Large Metropolitan Areas Large Metropolitan Fringe Medium Metropolitan Small Metropolitan Micropolitan Non- core y/o N= * p= p= p= p= p= * p= y/o N= p= ** p= p= p= p= p=0.109

Strengths:  Mortality data has been validated for breast cancer and Hispanic ethnic classifications on death certificates.  The use of state level data allows to detect patterns of geographical variations. Limitations:  Social and structural factors are suitable for hypothesis generation but not for hypothesis testing.  Small power for detection of ethnic variations within Hispanic population.

 The data showed significant geographic and racial variations among Hispanic populations.  Analytic epidemiologic studies are needed to ascertain the underlying reasons, with special reference to particularly strong protective effects among AI/AN and AA Hispanics relative to non-Hispanic AI/AN and AA groups.  The observation of relatively high rates among elderly API residents in the western region needs further exploration.  Consideration of these factors would contribute to public health planning efforts.

 This research was supported grant number 5 P20 MD from the National Institute of Minority Health and Health Disparities.  Contact: 