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Sharon Stein Merkin, MHS, Lori Stevenson, MPH and Neil Powe, MD, MPH, MBA

At the time of the study, Sharon Stein Merkin and Lori Stevenson were with the New York City Department of Health, New York, NY. Sharon Stein Merkin is now with Johns Hopkins University School of Hygiene and Public Health, Department of Epidemiology, Baltimore, Md. Neil Powe is with the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md.

Correspondence: Requests for reprints should be sent to Sharon Stein Merkin, MHS, 1275 25th St, NW, #705, Washington, DC 20037 (e-mail: smerkin{at}jhsph.edu).

Objectives. This study examined the association between a residential area's socioeconomic status (SES), race, and advanced-stage breast cancer in New York City.

Methods. The cross-sectional study design used breast cancer information for 37 921 cases diagnosed in New York City from 1986 to 1995. Residential education and income levels were based on the 1990 census and ascribed to each case by zip code. Associations between race, area SES, and advanced-stage breast cancer stage, and the interaction between race and SES, were evaluated in bivariate and multivariate analyses.

Results. After adjusting for age and year at diagnosis, living in areas with lower levels of education and income increased the odds of presenting with advanced-stage breast cancer by 50% for Black women and by 75% for White women. No significant qualitative interaction was present between area SES and race.

Conclusions. This study confirmed independent racial and socioeconomic differences in the risk of advanced-stage breast cancer in a large and diverse population. The results emphasize the need to improve screening practices and clinical treatment in both high-risk populations and high-risk geographic areas.

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