Affiliation:
1. Department of Public Health Sciences School of Medicine University of California, Davis Davis California USA
2. Department of Epidemiology and Biostatistics University of California, San Francisco San Francisco California USA
3. Division of Research Kaiser Permanente Northern California Oakland California USA
4. Helen Diller Family Comprehensive Cancer Center University of California, San Francisco San Francisco California USA
5. Zero Breast Cancer San Rafael California USA
6. Division of General Internal Medicine University of California, San Francisco San Francisco California USA
7. Public Health Sciences Division Fred Hutchinson Cancer Center Seattle Washington USA
8. Clinical Research Division Fred Hutchinson Cancer Center Seattle Washington USA
Abstract
AbstractBackgroundBreast cancer survivors are at a higher risk of cardiovascular disease (CVD) morbidity and mortality compared with the general population. The impact of objective social and built neighborhood attributes on CVD risk in a cohort of female breast cancer survivors was examined.MethodsThe 3975 participants came from the Pathways Study, a prospective cohort of women with invasive breast cancer from an integrated health care system in northern California. Women diagnosed with breast cancer from 2006 through 2013 were enrolled on average approximately 2 months after diagnosis. Their baseline addresses were geocoded and appended to neighborhood attributes for racial/ethnic composition, socioeconomic status (SES), population density, urbanization, crime, traffic density, street connectivity, parks, recreational facilities, and retail food environment. Incident CVD events included ischemic heart disease, heart failure, cardiomyopathy, or stroke. Cox proportional hazards models estimated associations of neighborhood attributes with CVD risk, which accounted for clustering by block groups. Fully adjusted models included sociodemographic, clinical, and behavioral factors.ResultsDuring follow‐up through December 31, 2018, 340 participants (8.6%) had CVD events. A neighborhood racial/ethnic composition measure, percent of Asian American/Pacific Islander residents (lowest quintile hazard ratio [HR], 1.85; 95% CI, 1.03–3.33), and crime index (highest quartile HR, 1.48; 95% CI, 1.08–2.03) were associated with the risk of CVD events independent of individual SES, hormone receptor status, treatment, cardiometabolic comorbidities, body mass index, and physical activity.ConclusionsWith the application of a socio‐ecological framework, how residential environments shape health outcomes in women with breast cancer and affect CVD risk in this growing population can be understood.