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Table 3 Summary of associations between residential environment and breast cancer incidence

From: Residential environment and breast cancer incidence and mortality: a systematic review and meta-analysis

Author, year (location)

Main area based measure/contrast

Stratification variable

Age-adjusted rates per 100,000

Ratio measures

P-value trend

Education

[17]Devesa, 1980 (United States)

Highest vs. lowest education

Whites

a95.9 vs. 71.9

b 1.33

 

Blacks

a52.0 vs. 43.8

b1.19

 

[16]Baquet, 1991 (United States)

Highest vs. lowest education

White

116 vs. 80.2

b Rate Ratio: 1.45

<0.01

Black

77.4 vs. 70.3

b Rate Ratio: 1.10

0.17

[39]Prehn, 1998 (United States)

Highest vs. lowest education

  

c Rate Ratio: 1.18 (1.13-1.22)

 

[43]Schlichting, 2012 (United States)

Lowest vs. highest education

All races

 

c Rate Ratio: IBC: 1.20 (1.12-1.30) Non-IBC: 0.87 (0.86-0.88)

 
 

Non-Hispanic White

 

c Rate Ratio: IBC: 1.20 (1.09-1.32) Non-IBC: 0.96 (0.95-0.97)

 
 

Black

 

c Rate Ratio: IBC: 1.28 (1.04-1.58) Non-IBC: 1.00 (0.97-1.03)

 

Income

[17]Devesa, 1980 (United States)

Highest vs. lowest income

Whites

a93.4 vs. 68.4

b1.37

 

Blacks

a48.2 vs. 47.3

b1.02

 

[16]Baquet, 1991 (United States)

Highest vs. lowest income

White

104.3 vs. 80.7

b Rate Ratio: 1.29

<0.01

Black

108.0 vs. 67.9

b Rate Ratio: 1.59

0.27

[39]Prehn, 1998 (United States)

Highest vs. lowest income

  

c Rate Ratio: 1.15 (1.11-1.19)

 

[35]Mackillop, 2000 (Canada and United States)

Highest vs. lowest income

Ontario

 

c Rate Ratio: 1.10 (1.04-1.16)

 

US

 

c Rate Ratio: 1.35 (1.31-1.40)

 

[27]Borugian, 2011 (Canada)

Lowest vs. highest income§

  

c Rate Ratio: 0.85 (0.84-0.86)

 

Poverty

[20]Krieger, 1990 (United States)

Lowest vs. highest poverty

Black, <40 years, High working class

11.1 vs. 9.0

b Rate Ratio: 1.23

 

Black, <40 years, Low working class

18.6 vs. 13.5

b Rate Ratio: 1.38

 

Black, ≥40 years, High working class

155.5 vs. 172.4

b Rate Ratio: 0.90

 

Black, ≥40 years, Low working class

238.7 vs. 256.8

b Rate Ratio: 0.93

 

White, <40 years, High working class

9.0 vs. 14.0

b Rate Ratio: 0.64

 

White, <40 years, Low working class

9.2 vs. 5.3

b Rate Ratio: 1.74

 

White, ≥40 years, High working class

214.7 vs. 209.9

b Rate Ratio: 1.02

 

White, ≥40 years, Low working class

248.8 vs. 284.8

b Rate Ratio: 0.87

 

[30]Gorey, 1998 (Canada)

Lowest vs. highest poverty

 

113.23 vs. 127.65

Standardized incidence rate Ratio: 0.89 (0.80-0.99)

 

[39]Prehn, 1998 (United States)

Lowest vs. highest poverty

  

c Rate ratio: 1.11 (1.08-1.14)

 

[46]Webster, 2008 (United States)

Lowest vs. highest poverty

Diagnosis year: 1990

 

d 1.27 (0.85-1.92)

 

Diagnosis year: 1980

 

d 0.94 (0.59-1.48)

 

[4]Harper, 2009 (United States)

Highest vs. lowest poverty

Diagnosis Year: 1987

328.7 vs. 381.6

b 0.86

 

Diagnosis Year: 2004

302.2 vs. 345.3

b 0.88

 

[19]Hausauer, 2009 (United States)

Highest vs. lowest poverty

Diagnosis Year: 2001

337.6 (326.2 – 349.2) vs. 370.4 (365.8-375.1)

b 0.91

 

Diagnosis Year: 2004

305.1 (294.5-316.1) vs. 322.4 (318.2-326.6)

b 0.95

 

[43]Schlichting, 2012 (United States)

Highest vs. lowest poverty§

All races

 

c Rate Ratio: IBC: 1.24 (1.12-1.37) Non-IBC: 0.86 (0.84-0.87)

 

Non-Hispanic white

 

c Rate Ratio: IBC: 1.12 (0.99-1.27) Non-IBC: 0.87 (0.86-0.89)

 

Black

 

c Rate Ratio: IBC: 1.32 (1.01-1.72) Non-IBC: 1.02 (0.98-1.06)

 

Composite SES

[23]Williams, 1991 (Australia)

Highest vs. lowest SES

 

203 vs. 146

b Rate Ratio: 1.39

<0.001

[22]Pollock, 1997 (United Kingdom)

Highest vs. lowest SES

 

SIR: 105 (95–115) vs. 95 (84–107)

b Standardized Incidence Rate Ratio: 1.11

 

[34]Liu, 1998 (United States)

Highest vs. lowest SES

  

c Relative Risk: 1.53 (1.49-1.57)

0.0001

[33]Krieger, 1999 (United States)

Working class poor vs. Professional

Asian and Pacific Islander

 

c Rate Ratio: 0.8 (0.7-1.0)

0.07

Black

 

c Rate Ratio: 1.0 (0.9-1.1)

0.89

Hispanic

 

c Rate Ratio: 0.5 (0.4-0.7)

0.00

White

 

c Rate Ratio: 1.2 (1.1-1.3)

0.12

[47]Yost, 2001 (United States)

Highest vs. lowest SES

Whites 15–49 years

 

1.78 (1.7-1.9)

<0.0001

Whites 50–64 years

 

1.26 (1.2-1.3)

<0.0001

Whites 65+ years

 

1.21 (1.2-1.3)

<0.0001

Blacks 15–49 years

 

1.70 (1.5-1.9)

0.026

Blacks 50–64 years

 

1.20 (1.1-1.4)

0.008

Blacks 65+ years

 

1.16 (1.0-1.3)

0.574

Hispanics 15–49 years

 

2.61 (2.4-2.8)

<0.0001

Hispanics 50–64 years

 

1.85 (1.7-2.0)

<0.0001

Hispanics 65+ years

 

1.78 (1.7-1.9)

<0.0001

Asian/Others 15–49 years

 

2.26 (2.0-2.5)

0.0001

Asian/Others 50–64 years

 

1.61 (1.5-1.8)

0.0016

Asian/Others 65+ years

 

1.54 (1.4-1.7)

<0.0001

[42]Robert, 2004 (United States)

Highest vs. lowest SES

  

e Odds Ratios: 1.20 (1.05-1.37)

 

[41]Reynolds, 2005 (United States)

Highest vs. lowest SES

  

c Rate Ratio: 1.59 (1.53-1.64)

<0.01

[32]Krieger, 2006 (United States)

Highest vs. lowest SES

San Francisco Bay Area

 

c IRR 1978–1982: 1.23 (1.10-1.38) 1988–1992: 1.40 (1.30-1.50) 1998–2002: 1.53 (1.43-1.65)

1978-1982: p=0.000; 1988–1992: p=0.000; 1998–2002 p=0.000

San Francisco Bay Area, non-Hispanic White

 

c IRR 1978–1982: 1.25 (1.07-1.45) 1988–1992: 0.96 (0.86-1.08) 1998–2002: 1.21 (1.06-1.38)

1978-1982: p=0.001; 1988–1992: p=0.368; 1998–2002 p=.000

San Francisco Bay Area, Black

 

c IRR 1978–1982: 0.82 (0.34-1.99) 1988–1992: 1.19 (0.84-1.68) 1998–2002: 0.90 (0.67-1.20)

1978-1982: p=0.159; 1988–1992: p=0.192; 1998–2002 p=0.495

Los Angeles county

 

c IRR 1978–1982: 1.51 (1.40-1.63) 1988–1992: 1.72 (1.64-1.81) 1998–2002: 1.79 (1.71-1.87)

1978-1982: p=0.000; 1988–1992: p=0.000; 1998–2002 p=0.000

Los Angeles county, non-Hispanic White

 

c IRR 1978–1982: 0.85 (0.77-0.93) 1988–1992: 1.16 (1.08-1.25) 1998–2002: 1.19 (1.11-1.26)

1978-1982: p=0.000; 1988–1992: p=0.000; 1998–2002 p=0.000

Los Angeles county, Black

 

c IRR 1978–1982: 1.13 (0.47-2.71) 1988–1992: 1.15 (0.82-1.60) 1998–2002: 1.21 (0.98-1.51)

1978-1982: p=0.027; 1988–1992: p=0.000; 1998–2002 p=0.003

Massachusetts

 

c IRR 1988–1992: 0.95 (0.88-1.02) 1998–2002: 1.35 (1.28-1.42)

1988-1992: p=0.020; 1998–2002 p=0.000

Massachusetts, non-Hispanic White

 

c IRR 1998–2002: 1.14 (1.07-1.21)

1998-2002: p=0.000

Massachusetts, Black

 

c IRR 1988–1992: 0.80 (0.35-1.83) 1998–2002: 0.68 (0.42-1.11)

1988-1992: 0=0.223; 1998–2002 p=0.911

[44]Shack, 2008 (United Kingdom)

Lowest vs. highest SES§

  

c 0.84 (0.82-0.85)

 

[46]Webster, 2008 (United States)

Highest vs. lowest SES

Diagnosis year: 1990

 

d 1.30 (0.86-1.96)

 

10 years prior to diagnosis: 1980

 

d 1.69 (1.10-2.59)

 

[31]Keegan, 2010 (United States)

Highest vs. lowest SES

  

c Rate Ratio: 1.79 (1.68-1.92)

 

[45]Spadea, 2010 (Italy)

Lowest vs. highest SES§

  

f 0.91 (0.84-0.98)

 

[37]Palmer, 2012 (United States)

Highest vs. lowest SES

  

g Rate Ratio: 0.92 (0.77-1.10)

0.54

Occupational class

[20]Krieger, 1990 (United States)

Highest vs. lowest working class

Black, <40 years

 

OR: 0.57 (0.32-1.04)

 

Black, ≥40 years

 

OR: 0.68 (0.53-0.88)

 

White, <40 years

 

OR: 1.04 (0.82-1.32)

 

White, ≥40 years

 

OR: 0.86 (0.81-0.92)

 

[39]Prehn, 1998 (United States)

Lowest vs. highest working class

  

c Rate Ratio: 1.13 (1.09-1.17)

 

Urbanization

[21]Nasca, 1992 (United States)

Urban vs. rural

 

SIR: 107 (104–110) vs. 83 (81–86)

b Standardized Incidence Rate Ratio: 1.29

<0.03

[40]Reynolds, 2004 (United States)

Urban vs. less urban

  

e Hazard Ratio: 1.33 (1.10-1.62)

 

[42]Robert, 2004 (United States)

Urban vs. rural

  

e Odds Ratios: 1.17 (1.06-1.28)

 

[18]Hall, 2005 (United States)

Metropolitan vs. non-Metropolitan non-adjacent

White

122.7 vs. 104.0

Rate Ratio: 1.18

 

Non-White

107.3 vs. 108.0

Rate Ratio: 0.99

 

Urban vs. rural

White

116.6 vs. 98.8

b Rate Ratio: 1.18

 

Non-white

91.0 vs. 100.9

b Rate Ratio: 0.90

 

[41]Reynolds, 2005 (United States)

Urban vs. small town/rural

  

c Rate Ratio: 0.98 (0.94-1.01)

 

[28]Clegg, 2009 (United States)

Rural vs. urban §

 

157.6 vs. 147.1

h 1.06 (0.94-1.19)

 

[19]Hausauer, 2009 (United States)

Urban vs. rural

Diagnosis year: 2001

375.1 (371.9-378.3) vs. 306.2 (292.9-320.1)

b 1.23

 

Diagnosis year: 2004

323.5 (320.6-326.4) vs. 283.1 (270.5-295.1)

b 1.14

 

[43]Schlichting, 2012 (United States)

Non-metro vs. metro§

All races

 

c Rate Ratio: IBC: 0.99 (0.90-1.08) Non-IBC: 0.94 (0.93-0.95)

 
 

Non-Hispanic white

 

c Rate Ratio: IBC: 0.95 (0.85-1.05) Non-IBC: 0.88 (0.87-0.89)

 
 

Black

 

c Rate Ratio: IBC: 1.40 (1.06-1.81) Non-IBC: 0.97 (0.92-1.01)

 

Hispanic enclave

[31]Keegan, 2010 (United States)

Lowest enclave vs. highest enclave

  

c Rate Ratio: 1.79 (1.67-1.92)

 

High SES low enclave vs. low SES high enclave

  

c Rate Ratio: 1.56 (1.50-1.63)

 

Relative index of inequality

[45]Spadea, 2010 (Italy)

Relative Index of Inequality

  

f 0.92 (0.82-1.02)

 

Natural log of relative income

[35]Mackillop, 2000 (Canada and United States)

Natural log of relative income for regression

Ontario

 

c Rate Ratio: 1.04 (1.00-1.08)

 

US

 

c Rate Ratio: 1.14 (1.12-1.17)

 
  1. aAge and area adjusted rates.
  2. bCalculated age-adjusted ratio measures for highest vs. lowest categories. Other ratio measures are presented as reported in the original article.
  3. cAge adjusted rates.
  4. d Odds ratios adjusted for age, race, body mass index (BMI), alcohol use, personal and family history of breast cancer (in a mother, sister, or daughter), menstrual history, reproductive history (no children, age at first birth below or above 30 years), history of mammography (ever/never), oral contraceptive use, pharmaceutical hormone use, and exposure to ionizing radiation.
  5. e Odds ratios adjusted for age, education, mammography screening, family history of breast cancer, parity, alcohol intake/day, body mass index, age at first birth, hormone replacement, oral contraceptives, and mutually for community SES index and Urbanicity.
  6. f Adjusted for age, area of birth, education, occupational class, and housing characteristics.
  7. g Adjusted for age, time period, parity, age at first birth, lactation, age at menarche, family history of breast cancer, age at menopause, oral contraceptive use, menopausal female hormone use, body mass index, vigorous exercise, alcohol consumption, region, mammography use, and years of education.
  8. h Rate ratios adjusted for age at survey and CPS cohort.
  9. §Estimates were re-calculated for meta-analysis to be consistent with the comparison of highest versus lowest ABRV.
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