The Geography of Survival: Neighbourhood Disadvantage and Breast Cancer Mortality for Black Women

By Lauren DeSouza- Master of Public Health, Simon Fraser Public Research University – Canada
https://nhcrisishouse.com/our-team/
Staff Research and Content Writer

Two women are diagnosed with Stage 3 breast cancer. Both undergo the same treatments and have similar household incomes. Neither smokes nor drinks, and both are moderately active. But one is much more likely to die from breast cancer than the other. The difference? Where they live.

Breast cancer is one of the deadliest forms of cancer in the U.S. While breast cancer affects women of all races, Black women are more likely to die from it than White women, even when they have similar diagnoses. A new study published in JAMA set out to understand how neighborhood deprivation impacts breast cancer mortality, specifically for Black women.

Due to the legacy of structural racism—including practices like redlining and segregation—Black Americans are more likely to live in neighborhoods with higher levels of deprivation and disadvantage than their White counterparts. Residents of underprivileged neighborhoods often lack access to essential economic and social resources that support the social determinants of health, such as education, income, housing quality, and transportation access. For Black women, higher breast cancer mortality is the result of many overlapping social and health factors, all underpinned by systemic racism.

Photo by Unseen Histories on Unsplash

What did this study do?

This nationwide cohort study used data from the Black Women’s Health Study (BWHS) to investigate whether neighborhood disadvantage, economic segregation, and personal experiences of racism are associated with breast cancer–specific and all-cause mortality among Black women. The researchers used three indices to quantify neighbourhood disadvantage: neighborhood concentrated disadvantage (nDIS), neighborhood SES [socioeconomic status] (nSES), and the Index of Concentration at the Extremes (ICE).

The BWHS is a nationwide cohort study of 59,000 Black women established in 1995. The study follows participants throughout their lives, and participants complete biennial questionnaires about major health conditions, medical history, reproductive history, lifestyle, personal experiences with racism, and many other factors. In this study, researchers identified BWHS participants with breast cancer diagnoses and cross-referenced them with national cancer registries and the National Death Index. There were 2290 breast cancer cases in the cohort analyzed for this study.

Photo by Hector Bermudez on Unsplash

This is the first study on neighborhood disadvantage and breast cancer mortality to utilize a cohort of Black women and to examine the role of interpersonal and institutional racism on breast cancer mortality. Previous studies on breast cancer mortality and neighborhood deprivation were conducted with predominantly White populations.

What is neighborhood disadvantage?

Neighborhood disadvantage refers to neighborhoods with a lack of economic and social resources. These social and economic disadvantages are concentrated within a specific geographic area, depriving residents of resources and opportunities. Disadvantaged neighborhoods often have high poverty and crime rates and lower access to quality education and health care. These hardships impact residents’ psychological and physical well-being.

Black Americans are more likely to live in disadvantaged neighborhoods compared to Americans of other races. The persistent legacy of structural racism, including residential segregation and redlining mortgage practices, systematically deprived predominantly Black neighborhoods of resources. This trend persists independent of individual achievement; Black people are more likely to live in economically deprived neighborhoods regardless of their individual socioeconomic status.

The nDIS index, one of the three used in this study to quantify neighbourhood disadvantage, uses six variables in its analysis:

Percentage of individuals living below the poverty line
Percentage of individuals receiving public assistance
Percentage of individuals living in female-headed households
Percentage of unemployed individuals
Percentage of individuals under 18 years of age
Percentage of Black residents

What were the results of the study?

This study found that Black women who lived in disadvantaged neighborhoods were more likely to die from breast cancer compared to those in more privileged neighborhoods.

Of the 2290 Black women with breast cancer included in the study, 602 passed away during the study, 305 of whom died from breast cancer. Those living in the most disadvantaged neighborhoods were 62% more likely to die from breast cancer compared to those living in the least disadvantaged neighborhoods.

Three of the six components of the nDIS index were most strongly associated with breast cancer mortality: neighborhoods with more female-headed households, with higher percentages of unemployed residents, and with higher percentages of Black residents.

For Black women with breast cancer, living in disadvantaged neighborhoods is associated with lower chances of breast cancer survival. This trend was strong and persisted even after the researchers accounted for the woman’s stage of cancer at diagnosis, the treatments they received, and their individual determinants of health (e.g., smoking status, level of physical activity, educational attainment).

The researchers were also interested in learning how personal experiences of racism impacted breast cancer mortality. However, the analysis did not find that women who experienced more racism, either in daily interactions or on a systemic level, had a higher risk of dying from breast cancer. That is, women who reported more frequent experiences of racism were not significantly more likely to die from breast cancer compared to women who reported fewer experiences of racism.

Why does neighborhood disadvantage affect breast cancer survival for Black women?

Systemic deprivation—at both the individual and neighborhood level—affects physical and mental health. Certain characteristics of systemically deprived neighborhoods may contribute to chronic stress, including prolonged exposure to noise and light pollution, limited access to nutritious food, and inadequate healthcare infrastructure. The stress associated with living in a disadvantaged neighborhood has been shown to impact breast cancer mortality across racial groups.

For Black women, however, this stress is compounded by the enduring effects of racist policies and practices that have historically deprived Black communities of resources and opportunities. Although this study did not compare mortality risk between racial groups, Black women are disproportionately more likely to live in disadvantaged neighborhoods than women of other races, making this a critical racial equity issue.

In addition, the legacy of structural racism has been shown to impose greater physiological stress on Black Americans. Higher allostatic load—a measure of how chronic stress manifests in the body—has been associated with larger tumor size and higher tumor grade at the time of cancer diagnosis. Chronic stress resulting from both personal and structural racism contributes to elevated allostatic load among Black Americans.

While personal experiences of racism were not found to be associated with increased breast cancer mortality in this study, race and racism undoubtedly play a role in the higher mortality risk observed among Black women.

Photo by National Cancer Institute on Unsplash

What are the key takeaways from this study?

This study found that Black women living in highly disadvantaged neighborhoods had a significantly higher risk of dying from breast cancer than Black women in less disadvantaged neighborhoods. This finding highlights the importance of addressing neighborhood-level socioeconomic deprivation to reduce breast cancer mortality. Because Black women are disproportionately likely to live in disadvantaged neighborhoods, investing in the social and economic infrastructure of these communities—such as improving access to quality healthcare, healthy food, safe housing, and stress-reducing environments—is a critical strategy for advancing equity in cancer outcomes.

References

Holder EX, Barnard ME, Xu NN, Barber LE, Palmer JR. Neighborhood Disadvantage, Individual Experiences of Racism, and Breast Cancer Survival. JAMA Netw Open. 2025;8(4):e253807. doi:10.1001/jamanetworkopen.2025.3807

Chen, J.C., Handley, D., Elsaid, M.I. et al. The Implications of Racialized Economic Segregation and Allostatic Load on Mortality in Patients with Breast Cancer. Ann Surg Oncol 31, 365–375 (2024). https://doi.org/10.1245/s10434-023-14431-1