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Epidemiologic Reviews Advance Access originally published online on August 12, 2009
Epidemiologic Reviews 2009 31(1):52-66; doi:10.1093/epirev/mxp007
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Epidemiologic Reviews © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ARTICLES

Do Lifestyle or Social Factors Explain Ethnic/Racial Inequalities in Breast Cancer Survival?

Fiona McKenzie and Mona Jeffreys

Correspondence to Fiona McKenzie, Centre for Public Health Research, Massey University, Private Bag 756, Wellington, New Zealand (e-mail: f.j.mckenzie{at}massey.ac.nz).

accepted for publication May 18, 2009.

Despite numerous studies documenting ethnic inequalities in breast cancer survival between minority and majority ethnic groups worldwide, reasons for these inequalities remain unclear. The authors performed a systematic review of published literature to identify studies that investigated the explanatory power of smoking, alcohol consumption, body mass index (BMI), and socioeconomic position (SEP) on ethnic inequalities in breast cancer survival. Sixteen studies were included in the review. From 5 studies, the authors found that differences in breast cancer survival between ethnic groups may be in part explained by BMI, but there was little evidence to implicate smoking or alcohol consumption as explanatory factors of this inequality. From 12 studies, the authors found that SEP explains part of the ethnic inequality in all-cause survival but that it was not evident for breast-cancer-specific survival. SEP explains more of the disparities among African-American versus white women in the United States compared with other ethnic comparisons. Furthermore, given social patterning of BMI and other lifestyle habits, it is possible that results for SEP and BMI are measuring the same effect. In this review, the authors make suggestions regarding the role of epidemiology in facilitating further research to better inform the development of effective policies to address ethnic differences in survival.

breast neoplasms • ethnic groups • healthcare disparities • health status disparities • meta-analysis • review • socioeconomic factors • survival analysis

BMI, body mass index • CI, confidence interval • HR, hazard ratio • SEP, socioeconomic position


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S. A. James
Epidemiologic Research on Health Disparities: Some Thoughts on History and Current Developments
Epidemiol. Rev., November 1, 2009; 31(1): 1 - 6.
[Abstract] [Full Text] [PDF]


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