Abstract P115: Urban Greenspace and All-Cause, Cardiovascular Disease-Specific, and Breast Cancer-Specific Mortality Among Older Women With Breast Cancer in the United States: Regional Variations Within the Surveillance, Epidemiology, and End Results and Medicare Linked Database

Background: Cardiovascular disease (CVD) and cancer are leading causes of morbidity and mortality in the US. Cancer survivors are at increased risk for adverse CVD outcomes due to multiple factors, including cardiotoxicity. Research suggests that greenspace contributes to better health outcomes, including CVD and breast cancer (BC). Objective: To explore relationships between urban greenspace and all-cause (ACM), CVD-specific (CVDSM), and BC-specific (BCSM) mortality and explore regional differences among older women diagnosed with BC in the US SEER-Medicare database. Methods: The 2011 national landcover database was linked to the 2010 census tracts and the 2010-2017 SEER-Medicare BC cohort. Women were included if they were 66+ years at diagnosis, had invasive BC, enrolled in Medicare Part A and Part B for 12 months before diagnosis, and had a census tract match for greenspace. Independent variable ‘greenspace’ was census tract percent tree canopy quartiles. Outcomes were all-cause, CVD, and BC-specific survival. Censoring was determined by the end of the study date, 12/31/2018. Covariates included age and comorbidity at BC diagnosis, race/ethnicity, dual enrollment in both Medicare and Medicaid eligibility, neighborhood social vulnerability, and tumor stage. Results: Regional variations in association between greenspace and BC survival were observed (Table 1). Greenspace is protective for ACM and BCSM in California, Washington, New Jersey, and Michigan, while no significant associations were observed in Georgia or Louisiana. For CVDSM, greenspace is protective in CA, while no significant differences were observed in Washington, Louisiana, and Michigan. An inverse relationship is observed for CVDSM in Georgia and New Jersey. Discussion: Our findings warrant more studies to investigate why greenspace is protective in some areas (i.e., CA, NJ, MI) or hazardous in other areas (i.e., GA). There is a need to identify critical factors and pathways contributing to these greenspace-survival differences.