Date of Award
1-1-2022
Document Type
Open Access Thesis
Degree Name
Master of Public Health (MPH)
Department
School of Public Health
First Advisor
Melinda Irwin
Abstract
Background: Known racial/ethnic disparities in cardiovascular disease (CVD) mortality among breast cancer survivors exist and it is well-documented that non-Hispanic Black (NHB) breast cancer survivors experience higher incidence of CVD mortality compared to NHW women. However, few studies have examined CVD mortality among Asian American, Native Hawaiian, and other Pacific Islanders (AANHPI) survivors, especially with respect to socioeconomic factors and rurality at the county-level. The aim of this study was to describe how county-level factors influence disparities in CVD mortality among AANHPI breast cancer survivors. Methods: Using Surveillance, Epidemiology, and End Results 18 registries, we analyzed a retrospective cohort of 60,184 AANHPI women diagnosed with first primary, invasive breast cancer at ages 18-84 years between 2000-2017 who survived at least one year. We used Poisson regression models to calculate relative risks (RR) of CVD mortality, accounting for rates in the general population of AANHPI, according to county-level tertiles of SES (measured by the Yost Index), median income, and degree of rurality. We then assessed for trends in county-level SES and tested for heterogeneity by rurality. We additionally calculated 10-year cumulative CVD mortality estimates accounting for competing risks (non-CVD deaths). Results: After adjusting for breast cancer stage, age, and year at diagnosis, AANHPI breast cancer survivors living in counties of the lowest SES had a 22% higher risk of CVD mortality (RR = 1.22; 95% CI [1.05, 1.41], p-trend
Recommended Citation
Ho, Katherine Luis, "Cardiovascular Disease Mortality Among Asian American And Pacific Islander Breast Cancer Survivors In The United States By Socioeconomic Status And Rurality, 2000-2018" (2022). Public Health Theses. 2157.
https://elischolar.library.yale.edu/ysphtdl/2157
