Supplemental Table 1. Associations between residential environment and breast cancer incidence
Author, Year
(Location)
Main Area Based
Measure/Contrast
Stratification
Variable
Age-Adjusted
Rates per
100,000
Ratio Measures
Devesa, 1980
(United States)
Education/
High education vs. low
education
Whites
a95.9
vs. 71.9*
b1.33
Blacks
a52.0
vs. 43.8*
b1.19
Income/
High income vs. low
income
Whites
a93.4
vs. 68.4*
b1.37
Blacks
a48.2
vs. 47.3
b1.02
Occupational class
composition/
High (66+%) vs. low
(<66%) working class
Black, <40 years
OR: 0.57 (0.321.04)
Black, ≥40 years
OR: 0.68 (0.530.88)
White, <40 years
OR: 1.04 (0.821.32)
White, ≥40 years
OR: 0.86 (0.810.92)
Krieger, 1990
(United States)
Poverty/
Low poverty (<20%
below poverty line) vs.
high poverty (20+%
below poverty line)
Baquet, 1991
(United States)
Education /
College graduate vs.
<12 years education
P-value
Trend
Black, <40 years,
High working class
11.1 vs. 9.0
b
Black, <40 years,
Low working class
18.6 vs. 13.5*
b
Black, ≥40 years,
High working class
155.5 vs. 172.4*
b
Black, ≥40 years,
Low working class
238.7 vs. 256.8
b
White, <40 years,
High working class
9.0 vs. 14.0
b
White, <40 years,
Low working class
9.2 vs. 5.3
b
White, ≥40 years,
High working class
214.7 vs. 209.9
b
White, ≥40 years,
Low working class
248.8 vs. 284.8
b
White
116 vs. 80.2
b
Rate Ratio:
1.45
<0.01
White, Low
population density
114.7 vs. 79.3
b
<0.01
Rate Ratio:
1.23
Rate Ratio:
1.38
Rate Ratio:
0.90
Rate Ratio:
0.93
Rate Ratio:
0.64
Rate Ratio:
1.74
Rate Ratio:
1.02
Rate Ratio:
0.87
Rate Ratio:
1.45
Income/
Highest vs. lowest
income
Williams, 1991
(Australia)
Nasca, 1992
(United States)
Pollock, 1997
(United Kingdom)
Gorey, 1998
(Canada)
Composite SES/
Highest SES decile vs.
lowest
Urbanization /
Most Urban vs. Rural
Townsend Index of
Social Deprivation/
Most Affluent vs. Most
Deprived
Poverty /
Low income vs. High
income
White, Medium
population density
113.7 vs. 80
b
Rate Ratio:
1.42
<0.01
White, High
population density
125.6 vs. 82.8
b
Rate Ratio:
1.52
<0.01
Black
77.4 vs. 70.3
b
Rate Ratio:
1.10
0.17
Black, Low
population density
82.1 vs. 79.6
b
Rate Ratio:
1.03
0.24
Black, Medium
population density
99.1 vs. 66.6
b
0.11
Black, High
population density
0.0 vs. 67.1
White
104.3 vs. 80.7
White, Low
population density
97.9 vs. 75.7
White, Medium
population density
Rate Ratio:
1.49
0.21
b
Rate Ratio:
1.29
<0.01
b
Rate Ratio:
1.29
<0.01
101.4 vs. 77.6
b
Rate Ratio:
1.31
0.01
White, High
population density
124.4 vs. 99.4
b
Rate Ratio:
1.07
0.13
Black
108.0 vs. 67.9
b
Rate Ratio:
1.59
0.27
Black, Low
population density
83.6 vs. 67.9
b
Rate Ratio:
1.23
0.86
Black, Medium
population density
115.8 vs. 66.9
b
Rate Ratio:
1.73
0.18
Black, High
population density
123.4 vs. 70.9
b
Rate Ratio:
1.74
0.55
203 vs. 146
b
Rate Ratio:
1.39
<0.001
SIR: 107 (104110) vs. 83 (8186)
b
<0.03
SIR: 105 (95-115)
vs. 95 (84-107)
b
113.23 vs. 127.65
Standardized
Incidence Rate
Standardized
Incidence Rate
Ratio: 1.29
Standardized
Incidence Rate
Ratio: 1.11
Ratio: 0.89
(0.80-0.99)
Liu, 1998
(United States)
Prehn, 1998
(United States)
Krieger, 1999
(United States)
Mackillop, 2000
(Canada and
United States)
Composite SES /
High SES vs. Low
SES
Education /
High vs. Low
Education
Income/
High vs. Low income
d Relative
Occupational Class/
Low vs. High working
class
Poverty/
Low vs. High poverty
c Rate
Composite SES /
Working class poor vs.
Professional
Income/
Richest vs. Poorest
Natural log of relative
income for regression
Yost, 2011
(United States)
Composite SES /
Highest SES vs.
Lowest
Risk:
1.53 (1.49-1.57)
0.0001
c Rate
Ratio:
1.18 (1.13-1.22)
c Rate
Ratio:
1.15 (1.11-1.19)
Ratio:
1.13 (1.09-1.17)
c Rate
Ratio:
1.11 (1.08-1.14)
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
0.12
Ontario
c Rate
US
c Rate
Ontario
c Rate
US
c Rate
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
Ratio: 1.2
(1.1-1.3)
Ratio:
1.10 (1.04-1.16)
Ratio:
1.35 (1.31-1.40)
Ratio:
1.04 (1.00-1.08)
Ratio:
1.14 (1.12-1.17)
Reynolds, 2004
(United States)
Robert, 2004
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
e
Urbanization /
Urban (San Francisco
Bay area) vs. less
urban (rest of
California excluding
Southern Coastal
area)
Composite SES /
Highest SES vs.
Lowest
Urbanization/
Urban vs. Rural
Wilkinson, 2004
(Australia)
Urbanization /
Urban vs. Rural
Hall, 2005
(United States)
Metropolitan areas /
Metropolitan vs. nonMetropolitan nonadjacent
Urbanization/
Most urban vs. Most
rural
Reynolds, 2005
(United States)
Hispanics 50-64
years
Composite SES /
Highest SES vs.
Lowest
Urbanization/
Hazard Ratio:
1.33 (1.10-1.62)
f
Odds Ratios:
1.20 (1.05-1.37)
f
Odds Ratios:
1.17 (1.06-1.28)
64.7 (63.4-66.1)
vs. 63.2 (60.965.6)
b
White
122.7 vs. 104.0
Rate Ratio: 1.18
Non-White
107.3 vs. 108.0
Rate Ratio: 0.99
White
116.6 vs. 98.8
b
Non-white
91.0 vs. 100.9
b
Rate Ratio:
1.02
Rate Ratio:
1.18
Rate Ratio:
0.90
All histologic
subtypes
c
Rate Ratio:
1.59 (1.53-1.64)
<0.01
Ductal
c
Rate Ratio:
1.58 (1.52-1.65)
<0.01
Lobular
c
Rate Ratio:
2.23 (2.07-2.40)
<0.01
Mixed ductal and
lobular
c
<0.01
All histologic
subtypes
c
Rate Ratio:
2.54 (2.33-2.77)
Rate Ratio:
0.98 (0.94-1.01)
Urban vs. Small
town/rural
Krieger, 2006
(United States)
Composite SES /
Ductal
c
Lobular
c
Mixed ductal and
lobular
c
San Francisco Bay
Area, all races
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=.000
San Francisco Bay
Area, non-Hispanic
White
c
1978-1982:
p=0.001;
1988-1992:
p=0.368;
1998-2002
p=.000
<5% poverty and
>=10% high income
vs. >=20% poverty
San Francisco Bay
Area, Black
San Francisco Bay
Area, Asian/Pacific
Islander
San Francisco Bay
Area, Hispanic
Los Angeles county,
all races
Los Angeles county,
non-Hispanic White
Rate Ratio:
0.93 (0.88-0.97)
Rate Ratio:
0.96 (0.89-1.04)
Rate Ratio:
1.14 (1.03-1.26)
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)
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)
c IRR
1978-1982: 0.73
(0.34-1.57)
1988-1992: 2.03
(1.54-2.66)
1998-2002: 1.46
(1.21-1.77)
c IRR
1978-1982: 1.17
(0.58-2.39)
1988-1992 : 2.07
(1.52-2.81)
1998-2002: 1.87
(1.44-2.44)
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)
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=0.159;
1988-1992:
p=0.192;
1998-2002
p=0.495
1978-1982:
p=0.472;
1988-1992:
p=0.000;
1998-2002
p=0.000
1978-1982:
p=0.344;
1988-1992:
p=0.000;
1998-2002
p=-0.001
1978-1982:
p=0.000;
1988-1992:
p=0.000;
1998-2002
p=0.000
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
Los Angeles county,
Asian/Pacific Islander
c
1978-1982:
p=0.060;
1988-1992:
p=0.000;
1998-2002
p=0.000
IRR
1978-1982: 1.21
(0.64-2.29)
1988-1992 : 1.36
(1.10-1.68)
1998-2002 : 1.34
(1.15-1.57)
c IRR
1978-1982:
1.29(0.79-2.10)
1988-1992: 1.77
(1.45-2.15)
1998-2002: 1.81
(1.51-2.18)
c IRR
1988-1992: 0.95
(0.88-1.02)
1998-2002: 1.35
(1.28-1.42)
c IRR
1998-2002: 1.14
(1.07-1.21)
c IRR
1988-1992: 0.80
(0.35-1.83)
1998-2002: 0.68
(0.42-1.11)
c IRR
1998-2002: 1.55
(0.93-2.57)
c IRR
1988-1992: 0.73
(0.24-2.26)
1998-2002: 1.69
(1.10-2.59)
c 0.84 (0.82-0.85)
Los Angeles county,
Hispanic
Massachusetts, all
races
Massachusetts, nonHispanic White
Massachusetts, Black
Massachusetts,
Hispanic
Massachusetts,
Asian/Pacific Islander
Shack, 2008
(United Kingdom)
Income deprivation /
Most deprived vs.
Least deprived
Webster, 2008
(United States)
Composite SES /
High SES vs. Low
Poverty/
Low poverty vs. High
Clegg, 2009
(United States)
Urbanization /
Rural vs. Urban
1990
g 1.30
(0.86-1.96)
1980
g 1.69
(1.10-2.59)
1990
g 1.27
(0.85-1.92)
1980
g 0.94
(0.59-1.48)
h 1.06
(0.94-1.19)
157.6 vs. 147.1
1978-1982:
p=0.000;
1988-1992:
p=0.000;
1998-2002
p=0.000
1988-1992:
p=0.020;
1998-2002
p=0.000
1998-2002:
p=0.000
1988-1992:
0=0.223;
1998-2002
p=0.911
1998-2002:
p=0.182
1988-1992:
0=0.762;
1998-2002
p=0.002
Harper, 2009
(United States)
Hausaer, 2009
(United States)
Poverty /
High (20+%) vs. low
(<10%) poverty
Poverty /
High (20+%) vs. low
(<10%) poverty
Urbanization/
Urban vs. rural
Keegan, 2010
(United States)
Composite Hispanic
Enclave /
Lowest vs. highest
Composite SES /
Highest vs. lowest
Combined SES and
Hispanic Enclave /
High SES low enclave
vs. low SES high
enclave
Spadea, 2010
(Italy)
Composite SES /
Very deprived vs. very
rich
Diagnosis Year: 1987
328.7 vs. 381.6
b 0.86
Diagnosis Year: 2004
302.2 vs. 345.3
b 0.88
2001
337.6 (326.2 –
349.2) vs. 370.4
(365.8-375.1)
b 0.91
2004
305.1 (294.5316.1) vs. 322.4
(318.2-326.6)
b
0.95
2001
375.1 (371.9378.3) vs. 306.2
(292.9-320.1)
b
1.23
2004
323.5 (320.6326.4) vs. 283.1
(270.5-295.1)
b
1.14
All stages of
diagnosis
c
Localized stage
c
Regional/Distant
stage
c
All stages of
diagnosis
c
Localized stage
c
Regional/Distant
stage
c
All stages of
diagnosis
c
Localized stage
c
Regional/Distant
stage
c
Rate Ratio:
1.79 (1.67-1.92)
Rate Ratio:
2.02 (1.84-2.22)
Rate Ratio:
1.41 (1.26-1.58)
Rate Ratio:
1.79 (1.68-1.92)
Rate Ratio:
2.22 (2.03-2.43)
Rate Ratio:
1.44 (1.29-1.60)
Rate Ratio:
1.56 (1.50-1.63)
Rate Ratio:
1.75 (1.66-1.86)
Rate Ratio:
1.34 (1.25-1.43)
I 0.91
(0.84-0.98)
I 0.92
Relative Index of
Inequality
Borugian, 2011
(Canada)
Palmer, 2012
(United States)
Schlichtling, 2012
(United States)
Income /
Lowest vs. highest
income
Composite SES /
Highest vs. lowest
Poverty /
Highest vs. lowest
poverty
(0.82-1.02)
Unstratified
c
19-39 years
c
40-49 years
c
50-59 years
c
60-69 years
c
70 or older
c
All sub-types
j
Rate Ratio: 0.92
(0.77-1.10)
0.54
ER+
j
Rate Ratio: 1.08
(0.82-1.41)
0.59
ER-
j
0.15
All races
c
Non-Hispanic white
Black
Hispanic white
Asian/pacific islander
Rate Ratio:
0.85 (0.84-0.86)
Rate Ratio:
0.75 (0.72-0.78)
Rate Ratio:
0.93 (0.91-0.95)
Rate Ratio:
0.91 (0.90-0.93)
Rate Ratio:
0.85 (0.84-0.87)
Rate Ratio:
0.80 (0.79-0.82)
Rate Ratio: 0.76
(0.53-1.08)
Rate Ratio:
IBC: 1.24 (1.121.37)
Non-IBC: 0.86
(0.84-0.87)
c Rate Ratio:
IBC: 1.12 (0.991.27)
Non-IBC: 0.87
(0.86-0.89)
c Rate Ratio:
IBC: 1.32 (1.011.72)
Non-IBC: 1.02
(0.98-1.06)
c Rate Ratio:
IBC: 1.18 (0.871.60)
Non-IBC: 0.80
(0.77-0.84)
c Rate Ratio:
IBC: 0.62 (0.161.68)
Non-IBC: 0.69
(0.62-0.76)
American
Indian/Alaska native
Education /
Highest vs. lowest
All races
Non-Hispanic white
Black
Hispanic white
Asian/pacific islander
American
Indian/Alaska native
Urbanization/
Non-metro vs. metro
All races
Non-Hispanic white
Black
Hispanic white
c
Rate Ratio:
IBC: 0.55 (0.191.41)
Non-IBC: 0.50
(0.43-0.58)
c Rate Ratio:
IBC: 1.20 (1.121.30)
Non-IBC: 0.87
(0.86-0.88)
c Rate Ratio:
IBC: 1.20 (1.091.32)
Non-IBC: 0.96
(0.95-0.97)
c Rate Ratio:
IBC: 1.28 (1.041.58)
Non-IBC: 1.00
(0.97-1.03)
c Rate Ratio:
IBC: 1.24 (0.971.60)
Non-IBC: 0.79
(0.77-0.82)
c Rate Ratio:
IBC: 1.13 (0.821.56)
Non-IBC: 0.92
(0.89-0.95)
c Rate Ratio:
IBC: 0.57 (0.221.35)
Non-IBC: 0.28
(0.24-0.33)
c Rate Ratio:
IBC: 0.99 (0.901.08)
Non-IBC: 0.94
(0.93-0.95)
c Rate Ratio:
IBC: 0.95 (0.851.05)
Non-IBC: 0.88
(0.87-0.89)
c Rate Ratio:
IBC: 1.40 (1.061.81)
Non-IBC: 0.97
(0.92-1.01)
c Rate Ratio:
IBC: 1.05 (0.691.55)
Asian/pacific islander
American
Indian/Alaska native
aAge
and area adjusted rates
bCalculated
cAge
Non-IBC: 0.99
(0.93-1.05)
c Rate Ratio:
IBC: 1.08 (0.551.92)
Non-IBC: 1.09
(1.02-1.16)
c Rate Ratio:
IBC: 1.35 (0.433.47)
Non-IBC: 1.40
(1.21-1.61)
ratio measures
adjusted rates
dAdjusted
for race/ethnicity and age
Hazard ratio adjusted for age, race, personal risk factors (family history of breast cancer, age at menarche,
pregnancy history, lifetime duration of breastfeeding, physical activity, alcohol consumption, BMI, menopausal
status, BMI with menopausal status interaction, and use of hormone therapy).
e
f Odds
ratios adjusted for age, education, mammography, 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
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.
g
h Rate
ratios adjusted for age at survey and CPS cohort
i Adjusted
for age, area of birth, and all the other reported variables
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
j
k Adjusted
for age, sex, nationality, marital status, level of urbanization, individual-level education and professional
status
l Adjusted
for race, county level variance, tumor stage, tumor grade, hormone receptor status, and treatment
(surgery/radiation)
Supplemental Table 2. Associations between residential environment and breast cancer mortality
Author, Year
Main Area Based
Measure/Contrast
Stratification
Variable
Age-Adjusted
Rates per
100,000
Income/
Northeast, <10,000
c 25.2
vs. 24.1
High income vs. low
income
South, <10,000
c 18.0
vs. 16.2
b
Central, <10,000
c
22.0 vs. 20.9
b
West, <10,000
c 20.7
vs. 20.9
Northeast, 250,000+
c 30.2
vs.28.1
South, 250,000+
c 25.1
vs. 22.9
Central, 250,000+
c
West, 250,000+
c 26.8
(Location)
Blot, 1977
(United States)
Williams, 1991
(Australia)
Pollock, 1997
(United
Kingdom)
Harper, 2009
(United States)
Dobson, 2010
(Australia)
Tian, 2011
(United States)
Panczak, 2012
(Switzerland)
Markossian,
2012
(United States)
Composite SES/
Highest SES decile
vs. lowest
Townsend Index of
Social Deprivation/
Most Affluent vs. Most
Deprived
Poverty/
High (20+%) vs. low
(<10%)
Area of residence /
Remote vs. major
urban centers
SES /
% Below poverty level
Swiss-SEP Index /
Lowest vs. highest
decile
Urban/Rural
residence/
Rural vs. urban
c
28.6 vs. 26.4
vs. 23.6
68 vs. 57
Ratio Measures
P-value Trend
Rate Ratio:
1.05
Rate Ratio:
1.11
b Rate Ratio:
1.05
b Rate Ratio:
0.99
b Rate Ratio:
1.07
b Rate Ratio:
1.08
b Rate Ratio:
1.14
b Rate Ratio:
1.19
SMR: 99 (84116) vs. 111 (93132)
b
Year of death: 1987
85.1 vs. 102.7
b0.83
Year of death: 2004
76.3 vs. 74.4
b1.02
Rate Ratio:
0.89
c Hazard
Ratio:
0.47 (0.06-3.42)
NA
NA
k
Hazard Ratio:
0.96 (0.87-1.05)
0.826
l Hazard
0.748
Ratio:
1.04 (0.85-1.26)