Transcript Maria C. Mejia de Grubb, MD, MPH; Barbara Kilbourne, PhD; Courtney Kihlberg, MD, MSPH; and Robert Levine, MD. Department of Family and.

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 35-64 and 65-85+ 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 65-85+ years), and
independent variables % Hispanics ≥25 years = annual
income below poverty, not high school graduates, and
renters.
Results
Age
Group
35-85+
Years
NonHispanic
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
Hispanic
AgeAdjusted
Rate
Hispanic:
NonHispanic
AgeAdjusted
Rate
MRR*
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 Group Hispanic
AI/AN
35-64
Years
AA
API
W
AI/AN
65-85 +
Years
AA
API
W
AgeAdjusted
Rate
3.2
(2.1 – 4.5)
7.9
(6.8 – 9)
11.4
(8.9 – 14.4)
19.7
(19.3 – 20.1)
9.4
(5.1 – 15.7)
29.9
(25.1 – 34.8)
51.6
(38.7 – 67.5)
64.3
(62.9 – 65.7)
NonHispanic
AI/AN
AA
API
W
AI/AN
AA
API
W
AgeAdjusted
Rate
17.6
(16.5 – 18.8)
43.6
(16.5 – 44.1)
17
(16.6 – 17.5)
26.6
(26.5 – 26.8)
66.2
(61.3 – 71.1)
127.1
(125.6 – 128.6)
43.3
(41.7 – 44.9)
110.9
(110.5 – 111.4)
Hispanic:
Non-Hispanic
MMR*
0.18
0.18
0.67
0.74
0.14
0.26
1.19
0.58
Age group
Census
Region
Northeast
Midwest
35-64
years
South
West
Age
Adjusted
Rate
Hispanic:
NonHispanic
AA
41.2
0.18
21
W
27
0.78
AA
8.3
AA
44.1
0.19
W
15.8
W
26.2
0.60
API
9.3
API
13.4
0.69
AA
11.7
AA
44.4
0.26
W
19.9
W
26.8
0.74
AI/AN
4.6
AI/AN
18
0.26
API
13.9
API
20.3
0.68
AA
3.5
AA
43.3
0.08
W
20.2
W
26.5
0.76
Age
Adjusted
Rate
NonHispanic
AA
7.5
W
Hispanic
MMR*
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
NonHispanic
Age
Adjusted
Rate
Hispanic:
NonHispanic
MMR*
27.6
AA
124.9
0.22
W
67.8
W
118.8
0.57
AA
43
AA
138.7
0.31
W
48.6
W
112.8
0.43
AA
36.7
AA
125.5
0.29
W
66.9
W
103
0.65
API
71.7
API
48.7
1.47
AA
23.4
AA
124.5
0.19
W
63.9
W
113.9
0.56
Hispanic
Age
Adjusted
Rate
AA
Northeast
Midwest
65-85+
years
South
West
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.
Age –Adjusted Breast Cancer Deaths
for 100,000 Population
30
25
NM
NY
PA
20
CO
NJ
MA
VA
UT
MI OK RI
KYMN
OH
CT
KS
NE ID
IN
HI
OR
MO
TNSC
MD
AL LA
WA
IAWI
AK
15
10
IL
TX
CA
AZ
FL
NV
GA
NC
y = 0.2735x + 13.749
R² = 0.447
5
0
0
5
10
15
20
25
30
Percent Hispanic Population
35
40
45
Age –Adjusted Breast Cancer Deaths
for 100,000 Population
90
NM
WY
80
MO
MN
NE
KY
MI
70
60
NY
AZ
CO
PA
IA
LA UT
OH MA
VA
IL
SC
40
TX
CA
HI
NJ
WA CT
50
FL
NV
INOK
KS
WIORMD
GA
30
y = 1.084x + 49.614
R² = 0.2199
20
10
0
0
5
10
15
20
Percent Hispanic Population
25
30
35
Hispanic White 35-64 y/o
Variable
Parameter Estimate
p value
Poverty %
Education %
Renters %
34.71
-9.88
-8.98
<0.0001
0.029
0.0006
Hispanic White 65-85+ y/o
Variable
Parameter Estimate
p value
Poverty %
Education %
Renters %
49.6
-69.54
-20.8
0.1054
0.0032
0.1003
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
Large
Metropolitan
Metropolitan
Areas
Fringe
35-64 y/o
N=39
0.346*
p=0.031
65 + y/o
N=34
0.168
p=0.342
Micropolitan
Noncore
-0.046
p=0.780
-0.200
p=0.223
-0.308*
p=0.056
0.173
p=0.327
0.133
p=0.452
0.208
p=0.109
Medium
Small
Metropolitan
Metropolitan
-0.094
p=0.567
-0.101
p=0.657
-0.447**
p=0.008
0.041
p=0.818
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 000516 from the
National Institute of Minority Health and
Health Disparities.
 Contact:
 [email protected]