The Effects of Social and Behavioral Determinants of Health on the Relationship between Race and Health Status in U.S. Breast Cancer Survivors

Yao Yuan, Monica Taneja, Avonne E. Connor

Research output: Contribution to journalArticle

Abstract

Background: To examine the association between race and health outcomes among U.S. breast cancer (BC) survivors and explore to what extent do social and behavioral factors contribute to racial disparities for these associations. Materials and Methods: Four hundred forty-one female participants diagnosed with BC in the National Health and Nutrition Examination Survey from 2007 to 2016 were included in this study. Poisson regression with robust variance was used to estimate the prevalence ratio (PrR) and 95% confidence intervals for the associations between race, diabetes, hypertension, and other cancers. Results: The PrR for co-occurrence of diabetes and hypertension was 2.21 (p < 0.001) and 1.62 (p < 0.001) times, respectively, among African Americans (AA) compared with non-Hispanic whites. Body mass index (BMI) explained 17.5% of the association between AA race and diabetes prevalence; a smaller reduction (7.8%) was observed adjusting for type of health insurance coverage, only. A 23.5% reduction was observed in the association between AA race and diabetes prevalence with adjustment for BMI and insurance. The association between AA race and hypertension prevalence was reduced by <6% with addition of individual risk factors, including education, insurance, poverty, obesity, smoking, and physical activity, and with adjustment of the combination of these factors. Conclusions: The association between AA race and diabetes prevalence among BC survivors may be partially explained by BMI and insurance coverage to a lesser extent. Interventions to improve outcomes among AA survivors should focus on weight management strategies.

Original languageEnglish (US)
Pages (from-to)1632-1639
Number of pages8
JournalJournal of Women's Health
Volume28
Issue number12
DOIs
StatePublished - Dec 2019

Fingerprint

Social Determinants of Health
African Americans
Health Status
Survivors
Breast Neoplasms
Body Mass Index
Insurance Coverage
Hypertension
Insurance
Social Adjustment
Nutrition Surveys
Poverty
Health Insurance
Obesity
Smoking
Confidence Intervals
Exercise
Education
Weights and Measures
Health

Keywords

  • African Americans
  • breast cancer
  • comorbidity
  • obesity
  • social factors

ASJC Scopus subject areas

  • Medicine(all)

Cite this

The Effects of Social and Behavioral Determinants of Health on the Relationship between Race and Health Status in U.S. Breast Cancer Survivors. / Yuan, Yao; Taneja, Monica; Connor, Avonne E.

In: Journal of Women's Health, Vol. 28, No. 12, 12.2019, p. 1632-1639.

Research output: Contribution to journalArticle

@article{e2ab1ff74f054f649a3df396db30986e,
title = "The Effects of Social and Behavioral Determinants of Health on the Relationship between Race and Health Status in U.S. Breast Cancer Survivors",
abstract = "Background: To examine the association between race and health outcomes among U.S. breast cancer (BC) survivors and explore to what extent do social and behavioral factors contribute to racial disparities for these associations. Materials and Methods: Four hundred forty-one female participants diagnosed with BC in the National Health and Nutrition Examination Survey from 2007 to 2016 were included in this study. Poisson regression with robust variance was used to estimate the prevalence ratio (PrR) and 95{\%} confidence intervals for the associations between race, diabetes, hypertension, and other cancers. Results: The PrR for co-occurrence of diabetes and hypertension was 2.21 (p < 0.001) and 1.62 (p < 0.001) times, respectively, among African Americans (AA) compared with non-Hispanic whites. Body mass index (BMI) explained 17.5{\%} of the association between AA race and diabetes prevalence; a smaller reduction (7.8{\%}) was observed adjusting for type of health insurance coverage, only. A 23.5{\%} reduction was observed in the association between AA race and diabetes prevalence with adjustment for BMI and insurance. The association between AA race and hypertension prevalence was reduced by <6{\%} with addition of individual risk factors, including education, insurance, poverty, obesity, smoking, and physical activity, and with adjustment of the combination of these factors. Conclusions: The association between AA race and diabetes prevalence among BC survivors may be partially explained by BMI and insurance coverage to a lesser extent. Interventions to improve outcomes among AA survivors should focus on weight management strategies.",
keywords = "African Americans, breast cancer, comorbidity, obesity, social factors",
author = "Yao Yuan and Monica Taneja and Connor, {Avonne E.}",
year = "2019",
month = "12",
doi = "10.1089/jwh.2018.7360",
language = "English (US)",
volume = "28",
pages = "1632--1639",
journal = "Journal of Women's Health",
issn = "1540-9996",
publisher = "Mary Ann Liebert Inc.",
number = "12",

}

TY - JOUR

T1 - The Effects of Social and Behavioral Determinants of Health on the Relationship between Race and Health Status in U.S. Breast Cancer Survivors

AU - Yuan, Yao

AU - Taneja, Monica

AU - Connor, Avonne E.

PY - 2019/12

Y1 - 2019/12

N2 - Background: To examine the association between race and health outcomes among U.S. breast cancer (BC) survivors and explore to what extent do social and behavioral factors contribute to racial disparities for these associations. Materials and Methods: Four hundred forty-one female participants diagnosed with BC in the National Health and Nutrition Examination Survey from 2007 to 2016 were included in this study. Poisson regression with robust variance was used to estimate the prevalence ratio (PrR) and 95% confidence intervals for the associations between race, diabetes, hypertension, and other cancers. Results: The PrR for co-occurrence of diabetes and hypertension was 2.21 (p < 0.001) and 1.62 (p < 0.001) times, respectively, among African Americans (AA) compared with non-Hispanic whites. Body mass index (BMI) explained 17.5% of the association between AA race and diabetes prevalence; a smaller reduction (7.8%) was observed adjusting for type of health insurance coverage, only. A 23.5% reduction was observed in the association between AA race and diabetes prevalence with adjustment for BMI and insurance. The association between AA race and hypertension prevalence was reduced by <6% with addition of individual risk factors, including education, insurance, poverty, obesity, smoking, and physical activity, and with adjustment of the combination of these factors. Conclusions: The association between AA race and diabetes prevalence among BC survivors may be partially explained by BMI and insurance coverage to a lesser extent. Interventions to improve outcomes among AA survivors should focus on weight management strategies.

AB - Background: To examine the association between race and health outcomes among U.S. breast cancer (BC) survivors and explore to what extent do social and behavioral factors contribute to racial disparities for these associations. Materials and Methods: Four hundred forty-one female participants diagnosed with BC in the National Health and Nutrition Examination Survey from 2007 to 2016 were included in this study. Poisson regression with robust variance was used to estimate the prevalence ratio (PrR) and 95% confidence intervals for the associations between race, diabetes, hypertension, and other cancers. Results: The PrR for co-occurrence of diabetes and hypertension was 2.21 (p < 0.001) and 1.62 (p < 0.001) times, respectively, among African Americans (AA) compared with non-Hispanic whites. Body mass index (BMI) explained 17.5% of the association between AA race and diabetes prevalence; a smaller reduction (7.8%) was observed adjusting for type of health insurance coverage, only. A 23.5% reduction was observed in the association between AA race and diabetes prevalence with adjustment for BMI and insurance. The association between AA race and hypertension prevalence was reduced by <6% with addition of individual risk factors, including education, insurance, poverty, obesity, smoking, and physical activity, and with adjustment of the combination of these factors. Conclusions: The association between AA race and diabetes prevalence among BC survivors may be partially explained by BMI and insurance coverage to a lesser extent. Interventions to improve outcomes among AA survivors should focus on weight management strategies.

KW - African Americans

KW - breast cancer

KW - comorbidity

KW - obesity

KW - social factors

UR - http://www.scopus.com/inward/record.url?scp=85076410755&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85076410755&partnerID=8YFLogxK

U2 - 10.1089/jwh.2018.7360

DO - 10.1089/jwh.2018.7360

M3 - Article

C2 - 30565965

AN - SCOPUS:85076410755

VL - 28

SP - 1632

EP - 1639

JO - Journal of Women's Health

JF - Journal of Women's Health

SN - 1540-9996

IS - 12

ER -