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The association of area-level social class and tobacco use with adverse breast cancer characteristics among white and black women: evidence from Maryland, 1992–2003

Overview of attention for article published in International Journal of Health Geographics, April 2015
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Title
The association of area-level social class and tobacco use with adverse breast cancer characteristics among white and black women: evidence from Maryland, 1992–2003
Published in
International Journal of Health Geographics, April 2015
DOI 10.1186/s12942-015-0007-7
Pubmed ID
Authors

Ann C Klassen, Aaron Pankiewicz, Stephanie Hsieh, Abigail Ward, Frank C Curriero

Abstract

In breast cancer, worse disease characteristics are associated with fewer social resources and black race. However, it is unknown whether social gradients have similar impact across race, and whether behaviors, including tobacco use, may explain a portion of the social gradient. We modeled relationships between area-level social class, tobacco spending and tumor characteristics, using 50,062 white and black cases diagnosed from 1992-2003 in Maryland, a racially and economically diverse state on the east coast of the United States. Multi-level models estimated the effect of area-level social class and tobacco consumption on tumor grade, size, and stage at diagnosis. Adjusting for race, age and year of diagnosis, higher social class was associated with lower risk for tumors with histological grade 3 or 4 (O.R. 0.96, 95% C.I. 0.94,0.99), those diagnosed at SEER stage 2 or later (O.R. 0.89, 95% C.I. 0.86, 0.91), and tumor size >2 cm (O.R. 0.87, 95% C.I. 0.84, 0.90). Higher tobacco spending was associated with higher risk for higher grade (O.R. 1.01, 1.00, 1.03) and larger tumors (O.R. 1.03, 95% C.I. 1.01, 1.06), but was not statistically significantly related to later stage (O.R. 1.00, 95% C.I. 0.98, 1.02). Social class was less protective for black women, but tobacco effects were not race-specific. Results suggest that in one U.S. geographic area, there is a differential protection from social class for black and white women, supporting use of intersectionality theory in breast cancer disparities investigations. Area-level tobacco consumption may capture cases' direct use and second hand smoke exposure, but also may identify neighborhoods with excess cancer-related behavioral or environmental exposures, beyond those measured by social class. Given the growing global burden of both tobacco addiction and aggressive breast cancer, similar investigations across diverse geographic areas are warranted.

Mendeley readers

The data shown below were compiled from readership statistics for 37 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 37 100%

Demographic breakdown

Readers by professional status Count As %
Student > Postgraduate 6 16%
Researcher 6 16%
Student > Master 5 14%
Other 3 8%
Student > Doctoral Student 3 8%
Other 8 22%
Unknown 6 16%
Readers by discipline Count As %
Medicine and Dentistry 8 22%
Social Sciences 5 14%
Nursing and Health Professions 3 8%
Psychology 3 8%
Agricultural and Biological Sciences 2 5%
Other 8 22%
Unknown 8 22%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 01 April 2015.
All research outputs
#11,160,853
of 12,545,316 outputs
Outputs from International Journal of Health Geographics
#400
of 475 outputs
Outputs of similar age
#188,886
of 227,868 outputs
Outputs of similar age from International Journal of Health Geographics
#1
of 1 outputs
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