ORIGINAL PAPER Metropolitan area racial residential segregation, neighborhood racial composition, and breast cancer mortality Emily F. Russell • Michael R. Kramer • Hannah L. F. Cooper • Sheryl Gabram-Mendola • Diana Senior-Crosby • Kimberly R. Jacob Arriola Received: 24 January 2012 / Accepted: 10 July 2012 / Published online: 24 July 2012 Ó Springer Science+Business Media B.V. 2012 Abstract Purpose There are significant relationships between racial residential segregation (RRS) and a range of health outcomes, including cancer-related outcomes. This study explores the contribution of metropolitan area RRS, census tract racial composition and breast cancer and all-cause mortality among black and white breast cancer patients. Methods This study has three units of analysis: women diagnosed with breast cancer (n = 22,088), census tracts where they lived at diagnosis (n = 1,373), and the metro- politan statistical area (MSA)/micropolitan statistical area (MiSA) where they lived at diagnosis (n = 37). Neigh- borhood racial composition was measured as the percent of black residents in the census tract. Metropolitan area RRS was measured using the Information Theory Index. Mul- tilevel Cox proportional hazards models examined the association of metropolitan area RRS and census tract racial composition with breast cancer and all-cause mor- tality. Survival analysis explored and compared the risk of death in women exposed to environments where a higher and lower proportion of residents were black. Results Breast cancer mortality disparities were largest in racially mixed tracts located in high MSA/MiSA segrega- tion areas (RR = 2.06, 95 % CI 1.70, 2.50). For black but not white women, as MSA/MiSA RRS increased, there was an increased risk for breast cancer mortality (HR = 2.20, 95 % CI 1.09, 4.45). For all-cause mortality, MSA/MiSA segregation was not a significant predictor, but increasing tract percent black was associated with increased risk for white but not black women (HR 1.29, 95 % CI 1.05, 1.58). Conclusions Racial residential segregation may influence health for blacks and whites differently. Pathways through which RRS patterns impact health should be further explored. Keywords Breast cancer Á Racial/ethnic disparities Á Racial residential segregation Introduction Black women with breast cancer have shorter survival than women of any other racial group with breast cancer in the United States [1]. Black women’s breast cancer mortality rate is 32 per 100,000 women; the rate is 22.8 per 100,000 women for white women [2]. Between 1996 and 2004, 5-year survival for breast cancer was 90 % for white women, but only 77 % for black women [3]. The reasons for these racial disparities in mortality are complex, and public health researchers are increasingly exploring social factors as possible determinants of these disparities [4]. Existing research on exogenous environmental risk factors for breast cancer has focused on exposure to pollutants and other toxins [5–7], urban versus rural differences in risk E. F. Russell (&) Á H. L. F. Cooper Á K. R. Jacob Arriola Department of Behavioral Sciences and Health Education, Rollins School of Public Health of Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA e-mail: edauria@emory.edu M. R. Kramer Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, GA, USA S. Gabram-Mendola Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA D. Senior-Crosby Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA 123 Cancer Causes Control (2012) 23:1519–1527 DOI 10.1007/s10552-012-0029-4