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

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Keywords

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

ASJC Scopus subject areas

  • Medicine(all)

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