The racial disparity in breast cancer mortality in the 25 largest cities in the United States § Steven Whitman a, *, Jennifer Orsi b , Marc Hurlbert c a Sinai Urban Health Institute, Room K 437, Mount Sinai Hospital, 1500 S. California Ave, Chicago, IL 60608-1797, USA b Metropolitan Chicago Breast Cancer Task Force, 1645 W. Jackson Blvd., Suite 450, Chicago, IL 60612, USA c Avon Foundation Breast Cancer Crusade, 1345 Avenue of the Americas, New York, NY 10105-0196, USA 1. Introduction Although White women are diagnosed with breast cancer more than Black women, Black women die from it at a much higher rate. For example, from 2000 to 2004 the age-adjusted breast cancer incidence rate for non-Hispanic White (NHW) women in the United States was 132.5 (per 100,000 women) compared to 118.3 for non-Hispanic Black (NHB) women, yielding an NHB:NHW rate ratio (RR) of 0.89. In the same years the mortality rates were 25.0 (age-adjusted, per 100,000 women) for NHW women and 33.8 for NHB women (RR = 1.35) [1]. Evidence shows this paradox exists for women both under 50 and over 50 [2]. These national figures are averages across many geographical units throughout the country. In a previous study we documented the nature of the racial disparity in breast cancer mortality in Chicago and found the NHB:NHW RR = 1.98 in 2005 compared with 1.36 in New York City and 1.38 for the United States during this same year [3]. This very large racial disparity in breast cancer mortality in Chicago created a great deal of attention in the media and the breast cancer community. As a result, the Metropolitan Chicago Breast Cancer Task Force was formed. This area-wide organization consists of over 100 individuals and 74 organizations devoted to eliminating the racial disparity in breast cancer through a multifaceted approach [4]. City-level data thus offer the potential to both understand health problems at the local level and to mobilize constituencies for programs or interventions for improvement. Despite this, we are not aware of any reports of breast cancer mortality analyses for cities other than Chicago. With this in mind, this paper presents race-specific breast cancer mortality rates for the 25 largest cities in the United States, measures the racial disparities for each city, analyzes societal (ecological) risk factors that we hypothesize could play a role in breast cancer disparities and discusses the insights and implications of such an analysis. 2. Methods The 25 most populous cities were determined using 2005 Census data [5]. Deaths where the cause was malignant neoplasm of the breast (ICD-10 = C50) were included in this analysis. Numerator data for 2005–2007 were abstracted from death files maintained by the Centers for Disease Control and Prevention in Atlanta, Georgia. Population-based denominators for the non-Hispanic White (NHW) Cancer Epidemiology xxx (2011) xxx–xxx A R T I C L E I N F O Article history: Received 28 July 2011 Received in revised form 18 October 2011 Accepted 25 October 2011 Available online xxx Keywords: Big cities Breast cancer Inequality Poverty Racial disparities Segregation A B S T R A C T Introduction: Although the racial disparity in breast cancer mortality is widely discussed there are no studies that analyze this phenomenon at the city level. Methods: We used national death files, abstracting those cases for which the cause was malignant neoplasm of the breast (ICD-10 = C50) for the numerators and American Community Survey data for the denominators. The 25 largest cities in the US were the units of analysis. Non-Hispanic Black:non-Hispanic White rate ratios (RRs) were calculated, along with their confidence intervals, as measures of the racial disparity. Seven ecological (city-level) variables were examined as possible correlates. Results: Almost all the NHB rates were greater than almost all the NHW rates. All but 3 of the RRs (range 0.78–2.09; median = 1.44) were >1, 13 of them significantly so. None of the RRs < 1 were significant. From among the 7 potential correlates, only median household income (r = À0.43, p = 0.037) and a measure of segregation (r = 0.42, r = 0.039) were significantly related to the RR. Conclusion: This is the first study that we have been able to locate which examines city-level racial disparities in breast cancer mortality. The results are of concern for several cities and for the field in general. A strategy for reducing this disparity in Chicago is in place and may serve as a model for other cities wanting to initiate a similar process. Clearly it is time to take action. ß 2011 Published by Elsevier Ltd. § There has been no research support for this project for any of the authors. * Corresponding author. Tel.: +1 773 257 5661; fax: +1 773 257 5680. E-mail addresses: Steve.Whitman@sinai.org, whist@sinai.org (S. Whitman), Jennifer_Orsi@rush.edu (J. Orsi), Marc.Hurlbert@avonfoundation.org (M. Hurlbert). G Model CANEP-375; No. of Pages 5 Please cite this article in press as: Whitman S, et al. The racial disparity in breast cancer mortality in the 25 largest cities in the United States. Cancer Epidemiology (2012), doi:10.1016/j.canep.2011.10.012 Contents lists available at SciVerse ScienceDirect Cancer Epidemiology The International Journal of Cancer Epidemiology, Detection, and Prevention jou r nal h o mep age: w ww.c an cer ep idem io log y.n et 1877-7821/$ – see front matter ß 2011 Published by Elsevier Ltd. doi:10.1016/j.canep.2011.10.012