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Disparities in Surgical Oncologic Care

E128: Neighborhood Disadvantage and the Protective Effects of Ethnic Enclaves in Breast Cancer

    ePoster Abstract Author(s)

  • Alexandra E. Hernandez, MD, MPH

    Research fellow
    University of Miami
    Miami, Florida, United States

    • Submitter(s)

  • Alexandra E. Hernandez, MD, MPH

    Research fellow
    University of Miami
    Miami, Florida, United States

    • Author(s)

  • Alexandra E. Hernandez, MD, MPH

    Research fellow
    University of Miami
    Miami, Florida, United States

  • LN

    Lauren Nahodyl, MS

    Biostatistician
    University of Miami, United States

  • MR

    Molly Ream, MS

    Doctoral Student
    Sylvester Comprehensive Cancer Center, University of Miami Health System, United States

  • KR

    Kristin Rojas, M.D.

    Assistant Professor of Surgery
    Dewitt Daughtry Department of Surgery, University of Miami, Miami, Florida, United States

  • Susan B. B. Kesmodel, MD, FACS

    Professor of Surgery
    Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, Florida, USA
    Miami, Florida, United States

  • RB

    Raymond Balise, PhD

    Associate Professor
    University of Miami, Miller School of Medicine, United States

  • MA

    Michael Antoni, PhD

    Professor
    Sylvester Comprehensive Cancer Center, University of Miami Health System, United States

  • Neha Goel, MD, MPH

    Associate Professor of Surgery
    Dewitt Daughtry Department of Surgery, University of Miami, Miami, Florida; Sylvester Comprehensive Cancer Center, Miami, FL
    Miami, Florida, United States

Introduction:

Neighborhood disadvantage has been associated with poor breast cancer outcomes such as later stage at diagnosis and shorter overall and cancer-specific survival. Because neighborhood disadvantage is a result of structural racism, minority populations tend to live in areas of greater disadvantage compared to Non-Hispanic White patients. Ethnic enclaves, or areas with higher densities of a specific ethnic group, may be protective against certain cancer outcomes. The objective of our study was to evaluate the role that ethnic enclaves play on the relationship between neighborhood disadvantage and breast cancer specific survival (BCSS) in a majority Hispanic population.

Methods:

This retrospective multi-institutional study included breast cancer (BC) patients with stage I-IV disease from 2005-2017. Patient addresses were used to link Area Deprivation Index (ADI) scores, a validated measure of neighborhood disadvantage. Ethnic enclaves were characterized by census tract level Hispanic density. Both measures were categorized into tertiles (T1-T3). Multiple mixed-effects Cox regression models for BCSS were performed.

Results:

5,027 female BC patients were included. 55.5% Hispanic, 27.0% non-Hispanic White (NHW), and 17.5% non-Hispanic Black (NHB). Women living in the most disadvantaged neighborhoods (T3) had shorter BCSS compared to those living in the most advantaged neighborhoods (T1). Hispanic density alone did not significantly predict survival. On the unadjusted model, the interaction between Hispanic density and ADI revealed that those living in the most disadvantaged neighborhoods (T3) with the highest Hispanic density (T3) had decreased mortality (HR 0.47 (95% CI 0.28-0.78), p=0.003). On the adjusted model controlling for age, income, race, Spanish origin, and nativity, these results remained significant (HR 0.58 (95% CI 0.34-0.98), p</span>=.039).

Conclusions:

Hispanic ethnic enclaves may be protective against breast cancer-specific mortality, suggesting that positive social factors may help combat the negative effects of neighborhood disadvantage on patients. Understanding the protective attributes of ethnic enclaves can help create effective cancer interventions and promote more equitable outcomes in minority populations.

Learning Objectives:

  • Define the concept of ethnic enclaves and their potential role in mitigating the adverse effects of neighborhood disadvantage on breast cancer specific survival, with a specific focus on Hispanic communities.
  • Describe the findings of a multi-institutional study that investigates the interplay between Hispanic ethnic enclaves and neighborhood disadvantage in predicting breast cancer mortality, considering both unadjusted and adjusted models.
  • Recognize the significance of understanding the protective factors of ethnic enclaves in improving cancer disparities and developing effective cancer interventions.