Association of cultural racism with breast cancer survival among United States adults, 2018-2020

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ID: 315920
2026
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Abstract
There are marked racial/ethnic disparities in breast cancer mortality. Cultural racism, expressed through societal norms, stereotypes, and implicit biases, may contribute. We utilized a previously validated state-level multidimensional latent measure, the cultural racism factor (CRF). Using data from the Surveillance, Epidemiology, and End Results (SEER) Program (2018-2020), we evaluated associations between CRF and risk of death using Cox proportional hazards models with state as random effect. We examined time-varying effects and conducted race and ethnicity-stratified analyses. Among 225 991 patients, 63% were Non-Hispanic (NH) White, 12% NH Black, and 16% Hispanic. In the overall cohort, patients in higher CRF states experienced 8% higher risk of death per unit increase in CRF after adjusting for covariates (aHR = 1.08; 95% CI: 1.05-1.11). Time-varying models revealed strongest effects early in follow-up (baseline HR = 1.30; 95% CI: 1.08-1.57), with attenuation over time (interaction HR = 0.99; 95% CI: 0.99-1.00). NH Black women exhibited a pattern suggestive of early elevated mortality risk that attenuated over follow-up (baseline HR = 1.14; 95% CI: 0.96, 1.35; interaction HR = 0.99; 95% CI, 0.97-1.00). In conclusion, cultural racism is associated with breast cancer survival at the population level, with time-dependent effects strongest early in follow-up.
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openalex_W7163534952 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Anjali Gupta, Oyomoare L. Osazuwa‐Peters, Andrea Thoumi, Hugo G Quezada-Pinedo, Nancy Krieger, Tyson Brown, Tomi Akinyemiju
Journal american journal of epidemiology
Year 2026
DOI
10.1093/aje/kwag126
URL
https://doi.org/10.1093/aje/kwag126
Keywords Keywords not found

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