Assessing upstream structural and social drivers of health in breast cancer survivorship: the Pathways Study Neighborhood Resource

Background: Research has linked neighborhood factors (e.g., air pollution, obesogenic environment) often associated with residential segregation to cancer disparities, including mortality. Limited research has explored these multilevel drivers of health, recognizing residential segregation as upstream of neighborhood social, built, and physical environment attributes. In this study we describe the neighborhood data resource of the Pathways Study, a diverse cohort of women diagnosed with breast cancer. Methods: Using data from multiple sources, including the 2010 U.S. Census, we appended census tract and block group-level measures that characterize the participants’ baseline neighborhoods. We examined distributions of neighborhood attributes by the Index of Concentration at the Extremes, a measure of racialized economic segregation, to demonstrate the relationships among these factors. Results: Twenty-eight percent of the participants resided in neighborhoods with the highest concentrations of high-income non-Hispanic White residents (i.e., most privileged neighborhoods, Q5) compared with only 9% who resided in neighborhoods with the highest concentrations of low-income residents from minoritized racial/ethnic groups (i.e., least privileged neighborhoods, Q1). Participants residing in less privileged neighborhoods had more exposure to detrimental neighborhood attributes including a higher overall pollution burden, markers of physical disorder (e.g., graffiti and garbage), more barred windows, and a higher crime index. Conclusions: For a cohort of breast cancer survivors, residing in neighborhoods with less privilege shows evidence of adverse neighborhood attributes across domains of social, built, and physical environments. Impact: This neighborhood infrastructure is well positioned to assess interactions across the multilevel factors contributing to health disparities in women with breast cancer.