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Breast cancer is the most commonly diagnosed cancer among US women across all racial/ethnic groups. Stage at diagnosis is one of the major factors determining breast cancer prognosis. The 5-year relative survival for breast cancer ranges from 99% for localized stage at diagnosis, to 84% for regional stage, and to 27% for distant (metastatic) stage breast cancer. The proportion of women diagnosed with breast cancer at later stages (regional and distant) in the US are higher among women with lower socio-economic status and among non-Hispanic Black women. Historic mortgage security redlining, implemented by the Home Owners’ Loan Corporation (HOLC) in the 1930s across numerous US cities, continues to have a negative influence on breast cancer stage at diagnosis, largely due to continued social and economic isolation and poor living environments resulting in many adverse consequences, including lower education, limited job opportunities, no/limited health insurance coverage, and suboptimal access to care, including cancer screening services. Additionally, studies have reported that living in areas with greater contemporary mortgage lending bias towards the non-Hispanic Black population (measured as higher odds of mortgage denial) is associated with late-stage breast cancer diagnosis in several US metropolitan areas. In this study, we aim to examine the association between the historic HOLC-based “redlining” and contemporary mortgage lending bias and stage of breast cancer at diagnosis among women aged 18 years and older in New Jersey diagnosed with first primary invasive breast cancer in 2010-2015 (N= 32,939). The study population was derived from the New Jersey State Cancer Registry. Historic “redlining” data based on 1930s neighborhood boundaries and transformed to corresponding 2010 census tracts borders were obtained from Inter-university Consortium for Political and Social Research. Mortgage lending bias score for the study period was calculated at the census tract level following methodology developed by Beyers and colleagues. Associations between census tract-level historic “redlining”, contemporary mortgage lending bias and breast cancer stage at diagnosis were evaluated using multinomial logistic regression models after adjusting for age alone, and then for age, race/ethnicity, marital status, and health insurance status. The study included 21,038 local, 9,765 regional, and 2,136 distant stage breast cancer cases. After adjusting for age, race/ethnicity, marital status, and health insurance, women living in historically redlined census tracts were more likely to be diagnosed with regional (OR=1.23; 95% CI 1.03-1.48) and distant (OR=1.55; 95% CI 1.09-2.22) stage breast cancer compared to women living in other census tracts. Odds for regional (OR=1.14; 95% CI 1.06-1.23) and distant (OR=1.33; 95% CI 1.16-1.53) stage breast cancer were also significantly higher for women living in areas with highest mortgage lending bias score. Stratifying by age (< 65 and >=65 years) showed similar patterns (data not shown). Both historic “redlining” and contemporary mortgage lending bias were associated with being diagnosed with breast cancer at later stages, notably distant stage. Targeting the legacy of systematic racism and addressing any contemporary discriminatory policies may help reduce breast cancer disparities in the diagnosis stage and thus mortality. Association between the historic redlining and contemporary mortgage lending bias and stage of breast cancer at diagnosis among women aged ≥18 years in New Jersey, 2010-2015 Note: For contemporary mortgage lending bias, highest score is indicative of highest bias (highest proportion of mortgage denial) towards Black people. *Fully adjusted model includes covariates: age, race/ethnicity, marital status, health insurance status ^Areas designated ”Best” were individual housing markets with sufficient levels of financing and were preserved exclusively for White and wealthy population. Areas defined as “Hazardous” were those lacking financial resources and were designated for Black and poor population. Citation Format: Daniel Wiese, Antoinette M. Stroup, Ahmedin Jemal, Kevin A. Henry, Farhad Islami. Associations of historic and contemporary “redlining” with breast cancer stage at diagnosis [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-06-01.

Mortality disparities by SES, including education, have steadily increased in the U.S. over the past decades. This study examined whether these disparities overall and for 7 major causes of death were exacerbated in 2020, coincident with the emergence of the COVID-19 pandemic.Using data on 7,123,254 U.S. deaths from 2017 to 2020, age-standardized death rates and mortality rate differences per 100,000 population and rate ratios comparing least with most educated were calculated by sex and race/ethnicity.All-cause death rates were approximately 2 times higher among adults with least than among those with most education. Disparities in all-cause mortality by educational attainment slightly increased from 2017 (rate ratio=1.97; 95% CI=1.95, 1.98; rate difference=739.9) to 2019 (rate ratio=2.04; 95% CI=2.03, 2.06; rate difference=761.3) and then greatly increased in 2020 overall (rate ratio=2.32; 95% CI=2.30, 2.33; rate difference=1,042.9) and when excluding COVID-19 deaths (rate ratio=2.27; 95% CI=2.25, 2.28; rate difference=912.3). Similar patterns occurred across race/ethnicity and sex, although Hispanic individuals had the greatest relative increase in disparities for all-cause mortality from 2019 (rate ratio=1.47; 95% CI=1.43, 1.51; rate difference=282.4) to 2020 overall (rate ratio=2.00; 95% CI=1.94, 2.06; rate difference=652.3) and when excluding COVID-19 deaths (rate ratio=1.84; 95% CI=1.79, 1.90; rate difference=458.7). Disparities in cause-specific mortality by education were generally stable from 2017 to 2019, followed by a considerable increase from 2019 to 2020 for heart disease, cancer, cerebrovascular disease, and unintentional injury. Among these causes of death, the relative increase in rate ratio from 2019 to 2020 was greatest for unintentional injury (24.8%; from 3.41 [95% CI=3.23, 3.60] to 4.26 [95% CI=3.99, 4.53]).Mortality disparities by education widened in the U.S. in 2020, during the COVID-19 pandemic. Further research is warranted to understand the reasons for these widened disparities.

State-specific information on lost earnings due to smoking-attributable cancer deaths to inform and advocate for tobacco control policies is lacking. We estimated person-years of life lost (PYLL) and lost earnings due to cigarette smoking-attributable cancer deaths in the United States nationally and by state. Proportions and numbers of cigarette smoking-attributable cancer deaths and associated PYLL among individuals aged 25 to 79 years in 2019 were calculated and combined with annual median earnings to estimate lost earnings attributable to cigarette smoking. In 2019, estimated total PYLL and lost earnings associated with cigarette smoking-attributable cancer deaths in ages 25 to 79 years in the United States were 2 188 195 (95% CI, 2 148 707-2 231 538) PYLL and $20.9 billion ($20.0 billion-$21.7 billion), respectively. States with the highest overall age-standardized PYLL and lost earning rates generally were in the South and Midwest. The estimated rate per 100 000 population ranged from 352 (339-366) in Utah to 1337 (1310-1367) in West Virginia for PYLL and from $4.3 million ($3.5 million-$5.2 million) in Idaho to $14.8 million ($10.6 million-$20.7 million) in Missouri for lost earnings. If age-specific PYLL and lost earning rates in Utah had been achieved by all states, 58.2% (57.0%-59.5%) of the estimated total PYLL (1 274 178; 1 242 218-1 306 685 PYLL) and 50.5% (34.2%-62.4%) of lost earnings ($10.5 billion; $7.1 billion-$13.1 billion) in 2019 nationally would have been avoided. Lost earnings due to smoking-attributable cancer deaths are substantial in the United States and are highest in states with weaker tobacco control policies.

Previous studies have reported on incidence and mortality patterns for individual genitourinary cancers in the USA. However, these studies addressed individual cancer types rather than genitourinary cancers overall.To comprehensively examine disparities and trends in the incidence and mortality for the four major genitourinary cancers (bladder, kidney, prostate, and testis) in the USA.We obtained incidence data from the National Cancer Institute 22-registry Surveillance, Epidemiology and End Results (SEER) database and the US Cancer Statistics database (Centers for Disease Control and Prevention) and mortality data from the National Center for Health Statistics to examine cross-sectional and temporal trends in incidence and death rates stratified by sex, race/ethnicity, and county.Age-adjusted incidence and death rates were calculated using SEER*Stat software. Temporal trends were analyzed using Joinpoint regression for a two-sided significance level of p 0.05.Incidence and mortality rates for bladder and kidney cancers were two to four times higher for men than for women. Among non-Hispanic White individuals, the highest incidence rates were found in the Northeast for bladder cancer and in Appalachia for kidney cancer, whereas the highest death rates for prostate cancer were found in the West. Incidence rates increased for cancers of the kidney and testis and for advanced-stage prostate cancer in almost all racial/ethnic populations and for bladder cancer in the American Indian/Alaska Native population. Death rates increased for testicular cancer in the Hispanic population and stabilized for prostate cancer among White and Asian American/Pacific Islander men after a steady decline since the early 1990s. Study limitations include misclassification of race/ethnicity on medical records and death certificates.We found persistent sociodemographic disparities and unfavorable trends in incidence or mortality for all four major genitourinary cancers. Future studies should elucidate the reasons for these patterns.In the USA, rates of cancer cases are increasing for kidney, testis, and advanced-stage prostate cancers in the overall population, and for bladder cancer in the American Indian/Alaska Native population. Differences in the rates by sex and race/ethnicity remain.

Although mammography is widely available in the United States, differences in accessibility in rural and urban areas and changes over time are not well described. In this study, we estimated the number and proportion of women aged 45-84 years who had limited travel time–based geographic accessibility to mammography by urban-rural status and state in the contiguous United States in 2006 and 2022. The proportion of women aged 45-84 years with limited accessibility to mammography did not substantially change from 2006 (12.7%; representing 7.5 million women) to 2022 (12.2%; 8.2 million women). Accessibility to mammography varied by state, but in 10 states, more than 26% of the statewide female population aged 45-84 years had limited accessibility in 2022. This proportion was substantially higher in rural areas (50.6% overall; ≥50% in 28 states in 2022) than in urban areas (3.0% overall). Increasing accessibility to mammography could increase utilization of breast cancer screening and, potentially, improve breast cancer survival.

Introduction Poverty is a known risk factor for burn injury and is associated with residency in food deserts and food swamps. Food deserts are areas with low or no access to nutritious, healthy foods while food swamps are areas with much higher access to high-calorie, unhealthy foods than to foods with good nutritious value. The purpose of our investigation was to determine the prevalence of residency in food deserts and food swamps in burn patients evaluated at an urban academic center and to determine the relationship between residency in these areas and the presence of patient comorbidities. Methods We performed a retrospective chart review of patients with burn injuries seen at an ABA verified urban academic center between January 2016 and January 2022. All patients over age 18 seen in the emergency department or admitted to the burn service were included in the study. Patient residential locations were used in conjunction with the Modified Retail Food Environment Index (mREFI) data to classify residency in food deserts and food swamps. Patient demographics and comorbidities were also recorded. Chi square and ANOVA analyses were completed to determine differences between the food desert, food swamp, and good access groups. Results A total of 3064 subjects were included in the study, of these 1370 (44.7%) were female and 1694 (55.3%) were male. In terms of access, 96 (3.1%) individuals lived in food deserts, 477 (15.6%) lived in good access areas, and 2490 (81.3%) resided in food swamps. This difference was found to be statistically significant (p < 0.0001). Age, sex, and BMI did not differ significantly between the three groups. A significantly higher percentage of food swamp residents had a diagnosis of diabetes (15.0%) as compared to subjects living in good food access areas (11.7%) and food deserts (8.3%), (p < 0.043). Hypertension was also found to be more prevalent in food swamps (24.8%) than food deserts (20.8%) and good access areas (19.3%), (p < 0.028). Finally, smoking was more common in food swamps (45.3%) than good access areas (40.4%) and food deserts (27.9%), (p < 0.0028). Conclusions A majority of burn patients reside in food swamps and residency in these areas is associated with a higher prevalence of hypertension, diabetes, and tobacco smoking. This is the first study to investigate the epidemiology of food access in an urban burn population. Applicability of Research to Practice Nutrition is known to be important to overall health and to wound healing in the setting of an acute injury. Our data contributes to the current literature on the role of nutrition in burns.

Introduction Many victims of burn injury live in food deserts or food swamps. Food deserts are low-income areas with minimal or no access to nutritious foods while food swamps are areas with much greater access to unhealthy, high-calorie foods. We examined the relationship between residency in a food swamp or food desert by census tract and wound healing. Methods We performed a retrospective review of burn patients who underwent split-thickness skin grafting at an ABA verified urban academic burn center between September 2018 and August 2022. Inclusion criteria were burn area less than 20% total body surface area (TBSA), age ≥ 18, and single operation for split-thickness skin grafting. Patient residential locations were used in conjunction with Modified Retail Food Environment Index (mREFI) data to classify residency in food deserts and food swamps. The primary outcome was time to donor site healing. Time-to-event Cox proportional regression analysis was performed to evaluate risk factors for poor wound healing. Results A total of 238 patients were included in the study, of whom 110 (46.2%) were female and 128 (53.8%) were male. Mean age was 48, BMI was 28.5, TBSA 3.7, and average days to donor site healing was 26. In categorizing residency by mREFI data, 45 (18.9%) individuals had good access, 11 (4.6%) resided in food deserts, and 182 (76.5%) resided in food swamps. Although time to healing was longer on average in the food desert (25.8 days) and food swamp (26.4 days) groups compared to the group with good access to food within ½ mile (22.9 days), this difference was not statistically significant. Not having diabetes was found to be associated with shorter time to wound healing (HR=1.68, 95% CI [1.15, 2.47], p=0.007). Living in a good access area was associated with faster wound healing (compared to swamp: HR=1.23, 95% CI [0.86, 1.75], compare to desert: HR=1.06, 95% CI [0.51, 2.20]), however this association was not statistically significant. Conclusions Residency in a food swamp or food desert does not significantly influence time to healing in burn injured patients. However, not having diabetes was associated with a shorter time to wound healing. This is the first study to compare residency in food deserts or food swamps by census tract level data with time to wound healing in an urban burn population. Applicability of Research to Practice Wound healing is a complex and important process known to be affected by malnutrition. Our data contributes to the current body of literature on nutrition and wound healing.

ImportanceThere are few data on state variation in racial and ethnic disparities in incidence of triple-negative breast cancer (TNBC) in the US, limiting the ability to inform state-level health policy developments toward breast cancer equity.ObjectiveTo quantify between and within racial and ethnic disparities in TNBC incidence rates (IRs) among US women across states.Design, Setting, and ParticipantsThis cohort study using population-based cancer registry data included data for all women with TNBC diagnosed from January 1, 2015, to December 31, 2019, identified in the US Cancer Statistics Public Use Research Database. Data were analyzed from July through November 2022.ExposuresState and race and ethnicity (Hispanic, non-Hispanic American Indian or Alaska Native, non-Hispanic Asian or Pacific Islander, non-Hispanic Black, or non-Hispanic White) abstracted from medical records.Main Outcomes and MeasuresThe main outcomes were diagnosis of TNBC, age-standardized IR per 100 000 women, state-specific incidence rate ratios (IRRs) using the rate among White women in each state as a reference for between-population disparities, and state-specific IRRs using the race and ethnicity–specific national rate as a reference for within-population disparities.ResultsThe study included data for 133 579 women; 768 (0.6%) were American Indian or Alaska Native; 4969 (3.7%), Asian or Pacific Islander; 28 710 (21.5%), Black; 12 937 (9.7%), Hispanic; and 86 195 (64.5%), White. The TNBC IR was highest among Black women (25.2 per 100 000 women), followed by White (12.9 per 100 000 women), American Indian or Alaska Native (11.2 per 100 000 women), Hispanic (11.1 per 100 000 women), and Asian or Pacific Islander (9.0 per 100 000 women) women. Racial and ethnic group–specific and state-specific rates substantially varied, ranging from less than 7 per 100 000 women among Asian or Pacific Islander women in Oregon and Pennsylvania to greater than 29 per 100 000 women among Black women in Delaware, Missouri, Louisiana, and Mississippi. Compared with White women, IRRs were statistically significantly higher in 38 of 38 states among Black women, ranging from 1.38 (95% CI, 1.10-1.70; IR, 17.4 per 100 000 women) in Colorado to 2.32 (95% CI, 1.90-2.81; IR, 32.0 per 100 000 women) in Delaware; lower in 22 of 22 states among Asian or Pacific Islander women, varying from 0.50 (95% CI, 0.34-0.70; IR, 5.7 per 100 000 women) in Oregon to 0.82 (95% CI, 0.75-0.90; IR, 10.5 per 100 000 women) in New York; and did not differ among Hispanic and American Indian or Alaska Native women in 22 of 35 states and 5 of 8 states, respectively. State variations within each racial and ethnic population were smaller but still substantial. For example, among White women, compared with the national rate, IRRs varied from 0.72 (95% CI, 0.66-0.78; IR, 9.2 per 100 000 women) in Utah to 1.18 (95% CI, 1.11-1.25; IR, 15.2 per 100 000 women) in Iowa, 1.15 (95% CI, 1.07-1.24; IR, 14.8 per 100 000 women) in Mississippi, and 1.15 (95% CI, 1.07-1.24; IR, 14.8 per 100 000 women) in West Virginia.Conclusions and RelevanceIn this cohort study, there were substantial state variations in racial and ethnic disparities in TNBC incidence, with Black women in Delaware, Missouri, Louisiana, and Mississippi having the highest rates among all states and racial and ethnic populations. The findings suggest that more research is needed to identify factors contributing to the substantial geographic variations in racial and ethnic disparities in TNBC incidence to develop effective preventive measures and that social determinants of health contribute to the geographic disparities in TNBC risk.

Background: Triple-negative breast cancer (TNBC) (i.e., estrogen receptor-negative, progesterone receptor-negative, and human epidermal growth factor receptor type 2-negative) is an aggressive subtype of breast cancer, more frequently diagnosed among non-Hispanic Black women than other racial/ethnic groups in the United States. TNBC risk also varies by location, but limited data exist for state-level variation in the racial/ethnic disparities in TNBC risk. Methods: Data for TNBC diagnosed at all ages during 2015-2019 were obtained from the National Program of Cancer Registries and Surveillance, Epidemiology & End Results for racial/ethnic groups classified as non-Hispanic American Indian/Alaska Native (AIAN), non-Hispanic Asian or Pacific Islander (API), non-Hispanic Black (Black), Hispanic, or non-Hispanic White (White). State-specific incidence rates were available for 8, 23, and 36 states for AIAN, API, and Hispanic women, respectively, and 38 states and Washington, D.C. for Black women and 50 states and Washington, D.C. (hereafter referred to collectively as “states”) for White women. State-specific rates were compared within and between racial/ethnic groups using incidence rate ratios (IRR). Results: Nationally, the age-standardized incidence rate of TNBC was the highest among Black women (25.1 per 100,000), followed by White (12.9 per 100,000), AIAN (11.1 per 100,000), Hispanic (11.1 per 100,000), and API (9.0 per 100,000) women. The highest state-specific rates were found among Black women in Delaware, Missouri, and Louisiana (>30 per 100,000) and the lowest rates were among API women in Oregon and Pennsylvania (< 7 per 100,000). State variations within a population were relatively larger among AIAN (2.8-fold) and Hispanic (2.3-fold) women, and smaller among White women (1.65-fold). Compared with White women, Black women had a higher rate of TNBC in all 39/39 states with the greatest IRRs in Delaware (2.31, 95%CI=1.90-2.81), Missouri (2.28, 95%CI=2.08-2.50), and Louisiana (2.20, 95%CI=2.02-2.38) and the lowest IRRs in Minnesota (1.38, 95%CI=1.12-1.68) and Colorado (1.38, 95%CI=1.12-1.68). In contrast, API women had a lower rate than White women in 22/23 states, except for Nevada, with the lowest IRR in Oregon (0.50, 95%CI=0.34-0.70) and the highest IRR in New York (0.82, 95%CI=0.75-0.90). The rate among Hispanic compared with White women did not differ statistically significantly in 23/36 states but was lower in 12/36 states, with the lowest IRR in Ohio (0.57, 95%CI=0.43-0.74), and higher in Massachusetts (1.21, 95%CI=1.04-1.39). The rate among AIAN compared with White women did not differ in 5/8 states but was lower in Arizona (0.53, 95%CI=0.38-0.73) and North Carolina (0.68, 95%CI=0.46-0.96), and higher in Oklahoma (1.30, 95%CI=1.09-1.54). Conclusions: State variations in TNBC incidence rates both within and between populations are substantial, signifying the important role of potentially modifiable risk factors in determining the risk of TNBC by state and race/ethnicity. This finding highlights the need for more research to identify factors contributing to these variations to develop more effective preventive measures. Meanwhile, to mitigate the impact of the disproportionate burden of TNBC across states and racial/ethnic groups, universal access to screening modalities and timely, guideline-concordant treatments is essential. Citation Format: Hyuna Sung, Daniel Wiese, Ismail Jatoi, Ahmedin Jemal. State variation in racial and ethnic disparities in triple-negative breast cancer rates: NPCR-SEER incidence data, 2015-2019 [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-03-24.