Neighborhood archetypes and breast cancer survival in California

Purpose: Previous studies on neighborhoods and breast cancer survival examined neighborhood variables as unidimensional measures (e.g. walkability or deprivation) individually and thus cannot inform how the multitude of highly correlated neighborhood domains interact to impact breast cancer survival. Neighbor-hood archetypes were developed that consider interactions among a broad range of neighborhood social and built environment attributes and examine their associations with breast cancer survival. Methods: Archetypes were measured using latent class analysis (LCA) fit to California census tract-level data. Thirty-nine social and built environment attributes relevant to eight neighborhood domains (so-cioeconomic status (SES), urbanicity, demographics, housing, land use, commuting and traffic, residential mobility, and food environment) were included. The archetypes were linked to cancer registry data on breast cancer cases (diagnosed 1996?2005 with follow-up through Dec 31, 2017) to evaluate their asso-ciations with overall and breast cancer-specific survival using Cox proportional hazards models. Analyses were stratified by race/ethnicity. Results: California neighborhoods were best described by nine archetypal patterns that were differen-tially associated with overall and breast cancer-specific survival. The lowest risk of overall death was observed in the upper middle class suburb (reference) and high status neighborhoods, while the highest was observed among inner city residents with a 39% greater risk of death (95% CI = 1.35 to 1.44). Results were similar for breast cancer-specific survival. Stratified analyses indicated that differences in survival by neighborhood archetypes varied according to individuals? race/ethnicity. Conclusions: By describing neighborhood archetypes that differentiate survival following breast cancer di-agnosis, the study provides direction for policy and clinical practice addressing contextually-rooted social determinants of health including SES, unhealthy food environments, and greenspace. (C) 2021 Elsevier Inc. All rights reserved.

Automated summary

This study explores the association between different neighborhood archetypes and breast cancer survival, finding that residents in specific types of neighborhoods have varying risks of survival. Additionally, the study highlights how survival outcomes for breast cancer patients differ across neighborhood types, with variations based on race/ethnicity.