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Living in a Disadvantaged NYC Neighborhood Is Associated with Poorly Differentiated Breast Cancer and Shorter Overall Survival
*Claire Miller, *Tiana Le, *Thomas Amburn, *Srinivasa Veeravalli, *Audree Tadros, *Stephanie Downs-Canner, *George Plitas, *Andrea Barrio, Monica Morrow,
*Neha GoelMemorial Sloan Kettering Cancer Center, New York, NY
ObjectivesNeighborhood disadvantage (ND) is associated with shorter breast cancer (BCa)-specific survival, independent of individual-level sociodemographic factors, access to care, tumor characteristics, and receipt of treatment. Recent translational studies in a South Florida population identified that social adversity-associated stress from living in ND is associated with activation of the sympathetic nervous system and downstream aggressive BCa biology, reflected in part, by upregulated proliferative pathways independent of subtypes. Since tumor grade is a clinical proxy for proliferation and tumor aggressiveness, the objective of this study was to evaluate the association between living in ND and tumor grade, along with overall survival (OS), in New York City (NYC), home to a distinct neighborhood landscape with the juxtaposition of advantaged and disadvantaged neighborhoods.
MethodsWomen with stage I–III BCa living in NYC treated from 2013-2024 were identified from an NCI designated cancer center’s prospectively maintained database. ND was stratified using the Area Deprivation Index (ADI), a validated tool that factors income, education, employment, and housing quality at the block group level to create a score from 1-10, with 1 being the most advantaged neighborhood and 10 being the least. The median ADI for the cohort was 4 and was used as the cutoff between neighborhood advantage (NA, ADI 1-4) and ND (ADI 5-10). Covariates included individual-level sociodemographic factors, tumor characteristics, and treatment (Table 1). Multivariable logistic regression and cox proportional hazards modeling were used to determine the association between ND and tumor grade and OS, respectively.
Results5452 women with BCa were included. 4142 (76%) lived in NA and 1310 (24%) lived in ND. Women living in ND were more likely to present with stage II/III disease (42% vs. 38% p=0.011), have poorly differentiated tumors (45% vs. 36%, p<0.001), and more frequently had ER-/HER2- disease (17% vs. 14%, p=0.019). A greater percentage of patients living in ND were Black (32% vs. 14%, p<0.001) and Medicaid-eligible (24% vs. 15%, p<0.001) (Table 1). On multivariable analysis, those living in ND had higher odds of poorly vs. well/moderately differentiated tumors (OR 1.32, CI 1.08-1.61), independent of age, race, stage, and subtype. ND was also associated with shorter OS (HR 1.39, CI 1.02-1.90), independent of age, race, insurance, BMI, stage, grade, and treatment.
ConclusionsWe found that women living in ND in NYC were more likely to present with poorly differentiated tumors and have worse OS, independent of sociodemographic, tumor, and treatment characteristics. These findings merit further inquiry and lay the foundation for future translational studies to externally validate the mechanisms by which ND “gets under the skin” to impact aggressive BCa tumor biology, and ultimately survival, in this large, diverse urban population treated in a tertiary care setting.
TABLE 1. Sociodemographic, tumor, and treatment characteristics for women living in advantaged versus disadvantaged neighborhoods in NYC
| Characteristic | Total (n=5452) | Advantaged Neighborhood
(ADI 1-4, n=4142) | Disadvantaged Neighborhood
(ADI 5-10, n=1310) | p-value |
| Age | <49 | 1656 | 1299 (31.4%) | 357 (27.3%) | <.001 |
| 50-69 | 2708 | 2001 (48.3%) | 707 (53.9%) |
| >70 | 1088 | 842 (20.3%) | 246 (18.8%) |
| Race | White | 3128 | 2578 (62.2%) | 550 (41.9%) | <.001 |
| Black | 1004 | 583 (14.1%) | 421 (32.1%) |
| Asian | 669 | 518 (12.5%) | 151 (11.5%) |
| Unknown | 651 | 463 (11.2%) | 188 (14.4%) |
| Hispanic | Yes | 627 | 410 (10.6%) | 217 (17.6%) | <.001 |
| No | 4476 | 3463 (89.4%) | 1013 (82.4%) |
| Insurance | Private or Medicare | 4495 | 3504 (84.6%) | 991 (75.6%) | <.001 |
| Medicaid | 957 | 638 (15.4%) | 319 (24.4%) |
| BMI | Normal | 1950 | 1606 (38.7%) | 344 (26.3%) | <.001 |
| Overweight | 1693 | 1257 (30.4%) | 436 (33.3%) |
| Obese | 1809 | 1279 (30.8%) | 530 (40.5%) |
| Clinical Stage | 1 | 3164 | 2449 (62.0%) | 715 (57.3%) | 0.011 |
| 2 | 1709 | 1258 (31.9%) | 451 (36.2%) |
| 3 | 319 | 238 (6.0%) | 81 (6.5%) |
| Tumor Grade | Well or Moderately | 2297 | 1835 (63.8%) | 462 (55.1%) | <.001 |
| Poorly | 1415 | 1038 (36.1%) | 377 (44.9%) |
| Tumor Subtype | ER+/HER2- | 3411 | 2607 (72.8%) | 804 (69.3%) | 0.019 |
| ER+/HER2+ | 402 | 309 (8.6%) | 93 (8.0%) |
| ER-/HER2+ | 241 | 176 (4.9%) | 65 (5.6%) |
| ER-/HER2- | 689 | 490 (13.7%) | 199 (17.1%) |
| Chemotherapy | No | 2906 | 2247 (54.3%) | 659 (50.3%) | 0.013 |
| Yes | 2546 | 1895 (45.8%) | 651 (49.7%) |
| Radiation | No | 1815 | 1401 (33.8%) | 414 (31.6%) | 0.14 |
| Yes | 3637 | 2741 (66.2%) | 896 (68.4%) |
| Endocrine Therapy | No | 1095 | 781 (18.9%) | 314 (23.9%) | <.001 |
| Yes | 4357 | 3361 (81.4%) | 996 (76.0%) |
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