Increasing Black:White disparities in breast cancer mortality in the 50 largest cities in the United States
Menée dans les 50 plus grandes villes des Etats-Unis, cette étude analyse l'évolution des disparités ethniques dans la mortalité par cancer du sein, sur la période 1990-2009
Introduction: This paper presents race-specific breast cancer mortality rates and the corresponding rate ratios for the 50 largest U.S. cities for each of the 5-year intervals between 1990 and 2009. Methods: The 50 largest cities in the U.S. were the units of analysis. Numerator data were abstracted from national death files where the cause was malignant neoplasm of the breast (ICD-9 = 174 and ICD-10 = C50) for women. Population-based denominators were obtained from the U.S. Census Bureau for 1990, 2000, and 2010. To measure the racial disparity, we calculated non-Hispanic Black:non-Hispanic White rate ratios (RRs) and confidence intervals for each 5-year period. Results: At the final time point (2005–2009), two RRs were less than 1, but neither significantly so, while 39 RRs were >1, 23 of them significantly so. Of the 41 cities included in the analysis, 35 saw an increase in the Black:White RR between 1990–1994 and 2005–2009. In many of the cities, the increase in the disparity occurred because White rates improved substantially over the 20-year study period, while Black rates did not. There were 1710 excess Black deaths annually due to this disparity in breast cancer mortality, for an average of about 5 each day. Conclusion: This analysis revealed large and growing disparities in Black/White breast cancer mortality in the U.S. and many of its largest cities during the period 1990–2009. Much work remains to achieve equality in breast cancer mortality outcomes.
Cancer Epidemiology 2014