Association of community-level deprivation with breast cancer risk and survival among women residing in the southeastern United States

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Shrubsole, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7594853/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background Studies on the association of community-level deprivation indices with breast cancer risk and survival after breast cancer diagnosis have yielded mixed results, and few have included large enough samples of low-income and ethnic minority individuals and considered individual-level risk factors. Methods This study included 43,384 cancer-free female participants enrolled from 2002-2009 in the Southern Community Cohort Study (SCCS), a prospective cohort study of predominantly low- income individuals and followed through December 2019 to ascertain incident breast cancer and survival outcomes. In-person or mailed baseline surveys collected information on demographic, reproductive and lifestyle factors. Neighbourhood deprivation index (NDI) was estimated based on participants’ residential zip codes and the 2000 census tract data. We conducted multivariable Cox regression analyses to evaluate the association of NDI with the risk of developing breast cancer and breast cancer-specific survival while adjusting for confounding effects of reproductive, lifestyle, clinical, and individual-level socioeconomic factors. Results Approximately 69% of participants were Black, 31% were white, and 78% had family income < $25,000/year. After a median follow-up of 12.8 years, 1,363 women were diagnosed with incident breast cancer (median age at diagnosis of 54.0 (IQR 13.0) years); 365 of them died, and 218 died from breast cancer. White women living in the least deprived communities had a significantly increased risk of developing breast cancer but not dying from breast cancer, with a hazard ratio (HR) of 1.44 (95% confidence interval (CI) 1.05-1.96) and 1.11 (95% CI; 0.48- 2.59), respectively. Among Black women, NDI was not associated with breast cancer risk or survival. Conclusion This large cohort of Black and white women with predominantly low-income background found no evidence that living in a deprived neighbourhood further increases the incidence and mortality of breast cancer. Breast cancer Risk Survival Community-level deprivation Neighbourhood Deprivation Index (NDI) Introduction Breast cancer is a significant cause of cancer-related morbidity and mortality among women in the United States of America (USA) and worldwide ( 1 , 2 ). Although breast cancer incidence for Black women was lower (127.8 per 100,000) than white women (133.7 per 100,000) in 2023 in the USA, Black women are more likely to die from breast cancer than their white counterparts ( 3 , 4 ). Black or African American women may experience breast cancer disparities, in part, due to the impact of socioeconomic status (SES) at individual, geographical, and societal level ( 5 , 6 ). Literature suggests an association of community-level deprivation, commonly accompanied by unhealthy diet, physical inactivity and limited access to health care, with increased risk of breast cancer incidence and mortality as well as other non-communicable diseases and health-related outcomes ( 7 – 9 ). However, explicit evidence is still lacking that defines the association of community-level deprivation with breast cancer risk and mortality along racial lines ( 10 , 11 ). Various indices have been adopted to evaluate community-level deprivation based on census tracts and socioeconomic domains of the individual and community ( 12 – 15 ). Studies that have assessed this relationship between community-level deprivation and various health outcomes found mixed results along racial lines and by individual-level SES ( 16 – 18 ). There may exist a parallel of area deprivation with individual socioeconomic status whereby they may have an additive or multiplicative effect on overall breast cancer risk or mortality ( 19 ). Some of the factors known to be associated with community deprivation are high exposure to alcohol or alcohol abuse, an unhealthy diet and a polluted environment that may have an impact on breast cancer risk and its outcome ( 20 , 21 ). In this study, we evaluated the association between community-level deprivation defined by the neighbourhood deprivation index (NDI) with risk and survival of breast cancer among female participants recruited to the Southern Community Cohort Study (SCCS). Methods Study population Our study included female participants from the Southern Community Cohort Study (SCCS), a large prospective cohort study of predominantly low-income individuals. The SCCS, described in detail elsewhere, enrolled from 2002 to 2009 a total of 84,797 English-speaking women and men between the ages of 40 and 79 from twelve southeastern states in the USA (Alabama, Arkansas, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia) ( 22 ). Eighty-six percent (86%) of participants were enrolled from Community Health Centres (CHCs), which serve low-income communities, while 14% came from the general population through mail invitation using an identical validated survey questionnaire, respectively. At CHC, a computer-assisted baseline survey was administered in person to capture individual social demographic, household income, reproductive and gynaecologic history, comorbid conditions, and lifestyle factors. The same survey questionnaire was administered to participants invited via mail, who were selected by stratified random sampling from the general population residing in the states targeted by the study. The Institutional Review Board (IRB) at the Vanderbilt University Medical Center and Meharry Medical College approved the study. All participants provided their written consent for participation according to the Declaration of Helsinki for medical research involving human participants ( 22 ). The questionnaire used in this study was designed for the SCCS that sought to investigate the unresolved questions about causes of cancer and other chronic diseases. The questionnaire is available at https://www.southerncommunitystudy.org/questionnaires.html . Our current cohort study included 43,384 female SCCS participants who had never been diagnosed with any malignancy during the year prior to study enrolment except for non-melanoma skin cancer ( 22 ). Exposure measurement Participants’ community-level socioeconomic status was ascertained based on their provided baseline residential address and zip code corresponding to the 2000 community-level census tract data. The neighbourhood deprivation index (NDI), the index used in our study to measure community-level deprivation, was derived from data based on eight 2000 census tract-level variables comprising education level, unemployment rates, managerial jobs, household costs, poverty levels, women-headed households, public assistance households, and owner-occupied homes of a particular community following the algorithm established by Messer et al. 2006 ( 7 , 23 ). The index distribution was categorised into quartiles, with quartile one (Q1) representing the least deprived neighbourhood while quartile four (Q4) represented the most deprived neighbourhood ( 20 ). Covariate description Study participants self-reported their race as White or black American, their highest level of education attained ranging from high school or less, some college and more than a college degree. Their body mass index BMI (kg/m 2 ) was calculated based on self-reported height and weight at enrolment. The cutoffs for BMI categories were determined by the following designations: underweight (BMI < 18.5), healthy and normal weight (BMI 18.5–24.9); in our study, we combined Underweight and healthy into a single category. Overweight (BMI 25–<30), and obese 1 (BMI 30-<35.0) and obese 2/3 according to CDC guidelines. Dietary intake was assessed using 89-item food frequency questionnaire variables developed specifically for a typical diet in the southeastern United States and validated with respect to nutrient intakes ( 24 ). Diet quality was evaluated using the Healthy Eating Index 2010 (HEI10) based on self-reported food frequency intake data to derive individual scores with a maximum score of 100 (range from 0 -100). The SCCS food frequency quartile data were linked to the United States Department of Agriculture (USDA) MyPyramid equivalents database to generate corresponding intakes for HEI food groups and calculate 12 components scores utilising the SAS code provided by the USDA. The derived quartiles for HEI10 were then assigned to each participant; the lowest quartile represents food intake poorly aligned to guidelines, while the highest quartile represents food intake most aligned to the USDGA ( 25 ). The total physical activity time for the participants was assessed using the SCCS Physical Activity Questionnaire (SCCS PAQ) based on several validated survey tools ( 26 ). The questionnaire evaluated a wide range of individual activities variables, including active and sedentary habits typically done at home, work, and during leisure time. Duration reports of active behaviours (hours/day) were converted to estimates (scores) of physical activity (PA) energy expenditure using Metabolic equivalent time (MET) hours/day) for specific activities assessed using the Compendium of Physical Activities (CAP). Participants’ co-morbidity score designed from the Charlson Co-morbidity Index (CCI) was developed empirically based on risk factors that predicted 1-year mortality. The index is based on numeric values ranging from 0 to 12, categorised as “0”, “1–3”, and 4+, with 0 having no comorbid conditions and 4 + with most comorbid conditions associated with increased 1-year mortality ( 27 ). All these variables were collected during the baseline survey. Outcome measurement Participants were followed through December 31, 2019, for incident breast cancer and survival through linkages with state and national registers. Participants’ breast cancer diagnoses were ascertained through linkage with the population-based Cancer registry from the 12 southeastern states, while vital statistics information was collected via linkage with the National Death Index ( 22 , 28 ). Incident breast cancer and breast cancer-specific mortality were ascertained by ICD-10, C50. Statistical Analysis Participants’ descriptive statistics by breast cancer occurrence or breast cancer-specific death for categorical baseline characteristics were reported in percentages, and comparisons were evaluated using the Pearson chi-square test for categorical variables. Continuous variables were summarised using median and interquartile range (IQR), and comparisons were conducted using Student t-test, analysis of variance (ANOVA) or Mann-Whitney (Wilcoxon Rank) statistical test. Time-to-event evaluation was performed using Kaplan-Meier survival analysis to estimate the probability of breast cancer risk (incidence case) and breast cancer-specific survival among study participants across NDI quartiles and by race stratification. Time interval references were calculated in months, for breast cancer incidence defined as months from enrollment to breast cancer diagnosis and end of follow-up for breast cancer incidence models while time for breast cancer survival models was defined as time in months from breast cancer diagnosis to death (for breast cancer-specific mortality analysis only) or end of follow-up. Variation in breast cancer risk and survival across levels of community-level deprivation and race was assessed using the log-rank test. Cox regression analyses were carried out to estimate hazard ratios and 95% confidence intervals for breast cancer risk, as well as total or breast cancer-specific mortality for association with NDI, while adjusting for potential confounders. The covariates adjusted in regression analyses are age at enrolment (for risk analysis), age at diagnosis (for mortality analysis), enrollment method, race (Black and white), age at menarche, menopause status, history of breast cyst, history of breast cancer in mother and sister, mammography screening, age at first birth, parity, body mass index (BMI), health eating index (HEI), physical activity, co-morbidity status, household income. For survival analyses, age at diagnosis, enrollment source (model 1), plus BMI, total physical activity time (MET), comorbidity status treatment variables: chemotherapy, surgery and radiotherapy (Model 2), plus household income and education status (Model 3) ( 29 ). We applied nested models to assess potential confounding effects of reproductive, lifestyle, clinical variables, and individual-level socioeconomic factors. Multiple imputation using chained equation using R package: (MICE), M = 1, was conducted to account for missing data of missing values at random (0.3%–5.8%). All analyses were performed using STATA version 17( 30 ). A two-sided test was used, and all p-values < 0.05 were considered statistically significant. Results The current study included 43,384 women with a median age of 51 years interquartile range (IQR) 13.0 years at baseline; 69.2% were black and 30.8% white. After a median follow-up of 12.8 (IQR 3.8) years, 1,363 women developed incident breast cancer, and 365 of them died subsequently, with 218 deaths resulting from breast cancer-specific causes. Median age at the time of death was 62.0 (IQR 15) years for breast cancer-specific mortality and 69.0 (IQR 12) years for death from other causes among those who developed incident breast cancer; however, the difference did not reach statistical significance (p = 0.69). Table 1 presents a summary of descriptive characteristics of study participants by breast cancer incidence (risk) and breast cancer-specific mortality status. Overall, participants who developed breast cancer were more likely to be enrolled from the general population than CHC (p < 0.05), to report some college or higher educational level status (p < 0.05), to be widowed (p =30) (p < 0.05). Other individual characteristics that differed significantly between participants who developed breast cancer compared to those who did not were post-menopause status, having a mammogram, a history of breast cysts, a history of breast cancer in mother or sister, with healthy eating index 10 quartile three (Q 3) and a co-morbidity score of 1-3. No significant differences were observed between the proportions of women who developed breast cancer and those who did not for participants’ age at enrolment, race, household income, age category at menarche, age at first birth, parity category and total physical activity time. A comparison between those who died from breast cancer-specific causes and the survivor’s household income, marital status, menopausal status, mammogram ever, breast cyst history and comorbid score showed a statistically significant difference between the two groups (p < 0.05). On the contrary, enrolment source, race, education attainment, body mass index, the age category of menarche, age at first birth, parity category, and history of breast cancer in mother and sister showed no significant differences between the survivors and those who died from breast cancer- specific cause. In addition, the age at enrolment of the participants was not statistically significantly different between those who died of breast cancer-specific causes compared to those who survived or died from other causes, p = 0.506. The baseline characteristics of study participants, as determined by the NDI quartile distribution, are shown in Table 2. Overall, participants who lived in different community-level deprivations showed a statistically significant difference in descriptive variables, including age at enrolment (for risk analysis), enrolment source, race (Black and white), age at menarche, menopause status, history of breast cyst, history of breast cancer in mother and sister, mammography screening, age at first birth, parity, BMI, HEI, physical activity, co-morbidity status and household income during mortality analyses. Only participants’ age at cancer diagnosis, age at death for breast cancer specific mortality, tumour stage and immunohistochemistry surrogate for tumour molecular classification did not reach statistically significant difference across the NDI quartiles (p > 0.05). Time-to-event analysis showed no significant difference in breast cancer risk for all participants across NDI and by race stratification (log-rank tests p value = 0.65 and p value = 0.46), respectively. Cox regression analysis for NDI association with breast cancer risk regardless of model covariates adjustments for unstratified race was non-significant, while analysis stratified by race showed that NDI was statistically significantly associated with breast cancer risk among White women: residing in the least deprived neighbourhood communities increased risk of breast cancer by 44% in the minimally adjusted; model 1 (adjusted hazard ratio (aHR)=1.44, 95% CI; 1.05-1.96); model 2 additionally adjusted for known breast cancer risk factors (aHR=1.43, 95% CI; 1.04-1.95) and with attenuation in Model 3 after adjusting for individual level of SES, household income and education status (aHR =1.37, 95% CI; 0.99-1.90). In contrast, no statistically significant association of NDI with breast cancer risk was found among Black American women, as shown in Table 3 . Overall, breast cancer-specific survival using Kaplan-Meier analysis did not show any statistically significant difference across participants’ NDI categories among White and Black breast cancer patients (p value = 0.33 and p value = 0.14), respectively . Multivariate analyses showed no statistically significant association between NDI and breast cancer-specific mortality among either White or Black in all models. The fully adjusted HR was 1.07 (95% CI; 0.36 - 3.18) for white patients and 0.79 (95% CI; 0.31- 1.10) for black patients residing in the least deprived communities, as shown in Table 4 . Similar null associations were found for total mortality (data not shown). Discussion In this large prospective cohort study, carried out among the residents of the southeastern states of the USA with predominately low household income, we found that white women living in the least deprived communities had an increased breast cancer risk compared to those living in neighbourhoods with high deprivation. This association persisted after adjustments for participant demographic, known breast cancer risk factors, reproductive and lifestyle factors, as well as individual levels of socioeconomic status. On the contrary, we found no significant association between NDI and breast cancer risk among Black women. No association was found between NDI and mortality after diagnosis of breast cancer among both white and black women. Breast cancer has been considered a disease of the affluent, with possible risk factors arising from delayed childbirth, less breast-feeding and use of hormone supplements practices that are commonly found among affluent women ( 31 ). Studies on breast cancer outcomes comparing risk and survival report a higher incidence of breast cancer occurrence among non-Hispanic White American women than non-Hispanic Black American women, while survival is lower among non-Hispanic Black women ( 32 – 35 ). Black women are 40% more likely to die from breast cancer compared to White women, while the survival of Black women has also been noted to be consistently 10 percentage points lower than that for White women, and this disparity has persisted over time/ decades ( 4 , 36 ). Previous studies have shown that community-level deprivation may be associated with increased cancer mortality in racially diverse communities ( 37 , 38 ). Studies have shown that the black population and those residing in deprived communities tend to have poor health outcomes ( 39 , 40 ). Eley et al., 1994, showed approximately 75% of the racial difference in survival was explained by sociodemographic variables at an individual level that appeared to act largely through racial differences in stage at diagnosis. In their study, after adjusting for geographic site and age, black participants remained at greater risk of dying at 2.2 times (95% CI; 1.8–2.8) than whites ( 41 ). Evidence on the association of cancer incidence and health outcomes with area-level deprivation in various parts of the globe tends to support community-level deprivation with increased risk of poor health outcomes such as non-communicable diseases, cancer and mortality ( 42 – 44 ). The multifactorial interplay of these neighbourhood environments and health behaviour factors may lead to additive or multiplicative effects, resulting in individuals residing in the most deprived communities experiencing increased risk and resulting in worse individual and community-level health outcomes ( 45 ). One of the mechanisms whereby neighbourhood socioeconomic environment may influence health outcomes is that disadvantaged neighbourhoods position individuals in conditions that may lead to unhealthy behaviours such as consuming unhealthy products such as alcohol, energy-dense foods resulting in obesity, and tobacco smoking ( 20 , 46 ). Disparities in access to health care services may also significantly contribute to poor health outcomes in deprived communities. Individuals with low socioeconomic status tend to live in communities with limited healthcare facilities, poor health-seeking behaviour and limited financial resources to seek care ( 47 ). In the USA, white women in general, have a higher breast incidence than black women, but black women experience higher mortality than their white counterparts ( 3 ). While some studies have found a smaller racial disparity in breast cancer when individual level of socioeconomic status was considered, disparities in incidence and survival among Black women persist ( 48 – 50 ). Our finding of white women residing in the least deprived communities had an increased risk of breast cancer is in line with the risk difference noted in the general population. Our study's failure to establish an association of community-level deprivation with the risk of developing breast cancer among SCCS Black women and death from breast cancer after diagnosis for White and Black women disagrees with some of the previous reports. The most significant difference between our study and previous studies is that our study participants, both Black and White women, were predominantly (86%) recruited from community healthcare facilities that provide services to individuals from communities with socioeconomic challenges ( 51 ). Therefore, White and Black women participants of our study have similar socioeconomic background and comparable access to health care. Our study suggests that when individual level of SES and access to health are held constant, the NDI is no longer a significant contributor to breast cancer disparities. The strengths of our study include prospective study design, inclusion of a large Black women population and low-income study participants and ability to adjust for individual-level SES and various lifestyle factors. However, our study population's relatively homogenous SES background may reduce the statistical power to detect small health effects associated with NDI. Future research on this topic should include individuals with a broad SES spectrum. Conclusion We found white women residing in the least deprived communities had an increased risk for breast cancer but not for mortality after breast cancer diagnosis. Neighbourhood deprivation index was not associated with breast cancer risk of breast cancer-specific mortality among Black women. This study indicates that community-level deprivation plays no major role in breast cancer risk and mortality disparity when individual level of SES and access to health care are accounted for. Abbreviations SCCS Southern community cohort study NDI Neighbourhood deprivation index BC Breast cancer CI Confidence interval HR Hazards ratio SES Socioeconomic status USA United States of America ANOVA Analysis of variance BMI Body mass index HEI Health eating index MET Metabolic turnover time Declarations Acknowledgements We would like to thank all the participants and the principal investigators for the Southern Community Cohort Study (SCCS), Dr Wei Zheng and Dr Martha Shrubsole at Vanderbilt University Medical Centre (VUMC), for their support in realising this manuscript. Conflicts of Interest The authors declare no competing of interests. a. Ethics approval and consent to participate The study was approved by the institutional review boards of Vanderbilt University and the Meharry Medical College, and participants gave voluntary written informed consent at study enrolment aligning with the Declaration of Helsinki and publication of anonymised research findings. The study’s general objectives, risks of the Southern Community Cohort Study, and long-term follow-up were explained to the participants. b. Consent for publication The author hereby confirms consent for the publication of the results in this manuscript with the accompanying data from the individual participants enrolled. The participant's informed consent included publication of the anonymised individual participants’ information detailed in the manuscript to be available and accessible to the public. c. Availability of data and materials Data availability described in the manuscript, codebook, and analytic code will be made available upon request after the investigator has obtained approval from the ethics committee and data sharing committee of the SCCS. Requests for data are to be made at www.southerncommunitystudy.org. d. Competing interests None to declare. e. Funding The research reported in this publication was supported by the National Cancer Institute (NCI) of the US National Institutes of Health (NIH) under the Award Number D43CA270474 and in partial by research funding from the Pfizer, Inc. The SCCS was supported by NCI grants (R01CA092447 and U01CA202979). The funding agencies have no role in data analysis and interpretation. The contents of the publication are the sole responsibility of the authors and don’t necessarily reflect the official views of the NCI and NIH. f. Authors’ contributions The following were the contributions of authors: Study conceptualisation: K.M 1 ., R.F 2 ., and X.S 4 .; study methodology: K.M 1 ., R.F 2 ., and X.S 4 .; data analysis: K.M 1 ., R.F 2 ., L.L 4 ., M.J.S 4 ., and X.S 4 .; manuscript writing and editing: K.M 1 ., X.S 4 ., V.K 3 ., W.M 5 ., J.P 4 ., X.S 4 ., L.L 4 ., M.J.S 4 ., and W.Z 4 .; additional SCCS resources: investigators X.S 4 ., L.L 4 ., M.J.S 4 ., and W.Z 4 . 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Tables Table 1 Descriptive characteristics for SCCS women participants by breast cancer incidence (risk) and breast cancer specific mortality (N=43,384) Exposure Breast Cancer Incidence Breast Cancer Specific mortality No (n=42,021) Yes (n=1,363) p-value No (n = 1,128) Yes (n = 218) p-value Age at enrollment, years Median (IQR) 51.0(13.0) 54.0 (13.0) 0.001 ** 54.0 (13.0) 53.0 (13.0) 0.783** n (%) n (%) n (%) n (%) Enrolment source Community Health Center (CHC) 37,272 (88.7) 1,168 (87.7) <0.001 960 (85.1) 192 (88.1) 0.254 General Population 4,749 (11.3) 195 (14.3) 168 (14.9) 26 (11.9) Race White American 12,956 (30.8) 416 (30.5) 0.806 357 (85.1) 58 (26.6) 0.140 African/Black America 29, 065 (69.2) 947 (69.5) 771 (14.9) 160 (73.4) Education status High School or Less 28,208 (65.0) 878 (67.0) 0.036 713 (63.2) 151 (69.3) 0.088 Some college or more 13,813 (31.8) 485 (33.0) 415 (36.8) 67 (30.7) Household Income category <$15,000 23,274 (56.2) 729 (54.4) 0.123 582 (52.4) 134 (63.2) 0.004 $15,000 - <$25,000 9,176 (22.2) 290 (21.6) 243 (21.9) 44 (20.8) $25,000+ 8,950 (21.6) 321 (24.0) 286 (25.7) 34 (16.0) Marital status Married 13,915 (33.1) 451 (33.1) <0.001 393 (34.8) 54 (24.8) 0.008 Divorced 14,292 (34.0) 449 (32.9) 369 (32.7) 74 (33.9) Widowed 5,659 (13.5) 240 (17.6) 195 (17.3) 41 (18.8) Never married 8,155 (19.4) 223 (16.4) 171 (15.2) 49 (22.5) Body mass index (BMI) Underweight/healthy 8,246 (19.6) 214 (15.7 0.003 172 (15.2) 40 (18.3) 0.459 Overweight 10,629 (25.3) 346 (25.4) 281 (24.9) 57 (26.1) Obese (class 1) 10,467 (24.9) 362 (26.6) 299 (26.5) 59 (27.1) Obese (class 2 and 3) 12,679 (30.2) 441 (32.4) 376 (33.3) 62 (28.4) Age category of menarche (years) 11 33,095 (78.8) 1,068 (78.4) 189 (16.8) 28 (12.8) Age at first birth (years) <=18 15,649 (37.2) 488 (35.8) 0.557 403 (35.7) 79 (36.2) 0.828 19-34 21,389 (59.9) 709 (52.0) 584 (51.8) 115 (52.8) None or 35+ 4,983 (11.9) 166 (12.2) 141 (12.5) 24 (11.0) Parity category Nulliparous 4,371 (10.4) 146 (10.7) 0.653 122 (10.8) 23 (10.6) 0.532 1 6,045 (14.4) 185 (13.6) 150 (13.3) 34 (15.6) 2 10,943 (26.0) 343 (25.2) 291 (25.8) 47 (21.6) 3+ 20,662 (49.2) 689 (50.6) 565 (50.1) 114 (52.3) Menopause status No 13,810 (32.9) 364 (26.7) <0.001 287 (25.4) 74 (33.9) 0.009 Yes 28,211 (67.1) 999 (73.3) 841 (74.6) 144 (66.1) Mammogram ever No 6,921 (16.5) 149 (10.9) <0.001 115 (10.2) 33 (15.1) 0.033 Yes 35,100 (83.5) 1214 (89.1) 1013 (89.8) 185 (84.9) Breast cyst history No 35,637 (84.8) 1,027 (75.4) <0.001 835 (74.0) 180 (82.6) 0.007 Yes 6,384 (15.2) 336 (24.7) 293 (26.0) 38 (17.4)  Breast cancer in mother or sister No 37,844 (90.1) 1143 (83.9) <0.001 939 (83.3) 190 (87.2) 0.151 Yes 4,177 (9.9) 220 (16.1) 189 (16.8) 28 (12.8) Healthy Eating Index 10 Quarter Mean (SD ) 59.4 (11.7) 61.1 (11.4) <0.001* 61.5 (11.4) 59.6 (11.2) 0.023* Total Physical Activity Time Median (IQR) 17.2 (17.8) 17.2 (17.7) 0.188** 17.2 (16.5) 14.1 (17.3) <0.001** Co-morbidity score 0 6,554 (15.6) 164 (12.0) <0.001 130 (11.5) 33 (15.1) 0.018 1 to 3 30,453 (72.5) 1,036 (76.0) 871 (77.2) 149 (68.3) 4+ 5,014 (11.9) 163 (12.0) 127 (11.3) 36 (16.5) Statistical test: Student t-test*, Mann-Whitney (Wilcoxon Rank) ** test for continuous variables and Pearson chi2 for categorical variables, statistical significance at 95 confidence interval, p value = 0.05. Table 2 Baseline characteristics of study participants by neighbourhood deprivation index (NDI) quartile distribution (N=43,384) Area Deprivation Index (NDI) Exposure Quartile 1 (n=4310) Quartile 2 (n=7101) Quartile 3 (n=9474) Quartile 4 (n=22499) p-value Enrolment Age, years Median (IQR) 52 (13) 51 (13) 52 (12) 50 (12) <0.001** Age at cancer diagnosis, years (n =1363) Median (IQR) 62 (12) 61 (14) 61 (14) 60 (13) 0.066** Age at death, years (breast cancer-specific mortality n = 218) Median (IQR) 62.0 (15.0) 60.0 (16.0) 63.0 (13.0) 61.5 (13.0) 0.115** Enrolment source Community Health Center 3,276 (76) 6,021 (84.4) 8,193 (86.5) 20,950 (93.1) <0.001 General Population 1,034 (24) 1,080 (15.2) 1,281 (13.5) 1,549 (6.9) Race White American 2,624 (60.9) 3,902 (55.0) 4,036 (42.6) 2,810 (12.5) <0.001 Black America 1,686 (39.1) 3,199 (45.0) 5,438 (57.4) 19,689 (87.5) Income category <$15,000 1,475 (35.0) 3,267 (46.7) 4,914 (52.7) 14,347 (21.6) <0.001 $15,000 to <$25,000 752 (17.8) 1,631 (23.3) 2,222 (23.8) 4,861 (21.9) $25,000+ 1,992 (47.2) 2,094 (30.0) 2,186 (23.5) 2,999 (13.5) Education status High school or less 1,953 (62.9) 4,467 (62.9) 6,383 (67.4) 16,283 (72.4) <0.001 Some college or more 2,357 (54.7) 2,634 (37.1) 3,091 (32.6) 6,216 (27.6) Marital status Married 1,878 (43.6) 2,959 (41.7) 3,656 (38.6) 5,873 (26.1) <0.001 Divorced 1,459 (33.9) 2,313 (32.6) 3,157 (33.3) 7,812 (34.7) Widowed 445 (10.3) 887 (12.5) 1,308 (13.8) 3,259 (14.5) Never married 528 (12.3) 942 (13.3) 1,353 (14.3) 5,555 (24.7) Mammogram ever No 423 (9.8) 1,022 (14.4) 1,293 (13.6) 4,332 (19.3) <0.001 Yes 3,887 (90.2) 6,079 (85.6) 8,181 (86.4) 18,167 (80.7) Breast cyst history No 3,345 (77.6) 5,792 (81.6) 7,886 (83.2) 19,641 (87.3) <0.001 Yes 965 (22.4) 1,309 (18.4) 1,588 (16.8) 2,858 (12.7) Age Category of menarche <=11 937 (21.7) 1,618 (22.8) 2,079 (21.9) 4,587 (20.4) 11 3,373 (78.3) 5,483 (77.2) 7,395 (78.1) 17,912 (79.6) Age at first birth (35+), years <=18 1,044 (24.2) 2,271 (32.0) 3,247 (34.3) 9,575 (42.6) <0.001 19-34 2,532 (58.7) 3,933 (55.4) 5,180 (54.7) 10,453 (46.5) None or 35+ 734 (17.0) 897 (12.6) 1,047 (11.1) 2,471 (11.0) Parity category Nulliparous 625 (14.5) 777 (10.9) 936 (9.9) 2,179 (9.7) <0.001 1 674 (15.6) 1,069 (15.1) 1,364 (14.4) 3,123 (13.9) 2 1,383 (32.1) 2,136 30.1) 2,614 (27.6) 5,153 (22.9) 3+ 1,628 (37.8) 3,119 (43.9) 4,560 (48.1) 12,044 (53.5) Menopause status No 1,315 (30.5) 2,180 (30.7) 2,727 (28.8) 7,952 (35.3) <0.001 Yes 2,995 (69.5) 4,921 (69.3) 6,747 (71.2) 14,547 (64.7)  Breast cancer in mother or sister No 3,813 (88.5) 6,358 (89.5) 8,468 (89.4) 20,348 (90.4) <0.001 Yes 497 (11.5) 743 (10.5) 1,006 (10.6) 2,151 (9.6) Healthy Eating Index 10 Quarter Mean, SD 62.5 (12.1) 59.6 (11.8) 59.6 (11.8) 58.7 (11.4) <0.001* Total Physical Activity Time Median, (IQR) 17.2 (16.1) 17.4 (18.2) 17.2 (17.8) 17.2 (17.7) <0.001** AJCC Group Stage I 50 (46.3) 69 (41.6) 115 (48.9) 174 (36.6) 0.092 II 36 (18.0) 54 (32.5) 72 (30.6) 194 (40.7) III 18 (16.7) 33 (19.9) 35 (14.9) 77 (16.2) IV 4 (3.7) 10 (6.0) 13 (5.53) 31 (6.5) Breast Cancer Molecular Subtype ER+ and/or PR+/HER2- 77 (52.7) 107 (48.2) 152 (29.2) 312 (45.5) 0.054 HER2+/ER+ and/or PR+ 13 (8.9) 23 (10.36) 20 (6.5) 56 (8.2) ER-/PR-/HER2+ 6 (4.1) 6 (2.7) 21 (6.8) 38 (5.5) ER-/PR-/HER2- 13 (8.9) 24 (10.8) 40 (12.9) 121 (17.6) Unknown 37 (25.3) 62 (27.9) 76 (24.6) 159 (23.18) Co-morbidity score 0 810 (18.8) 1,111 (15.6) 1,390 (14.7) 3,407 (15.1) <0.001 1-3 3,132 (72.7) 5,150 (72.5) 6,910 (72.9) 16,297 (72.4) 4+ 368 (8.5) 840 (11.8) 1,174 (12.4) 2,795 (12.4) Statistical test: ANOVA*, Mann-Whitney (Wilcoxon Rank) ** test for continuous variables and Pearson chi2 for categorical variables, statistical significance at 95 confidence interval, p value = 0.05. AJCC American Joint Committee on Cancer, ER estrogen receptor, PR progesterone receptors, HER2 human epidermal growth factor-2 receptor. Table 3 Association of neighbourhood deprivation index (NDI) with breast cancer risk for all races and by race stratification Exposure Cases (N=1,347) Model 1 Mode 2 Model 3 aHR (95% CI) aHR (95% CI) aHR (95% CI) ALL Races Quartile 4 686 1.0 1.0 1.0 Quartile 3 309 1.02 (0.89-1.17) 0.99 (0.87-1.14) 1.22 (0.91-1.65) Quartile 2 222 1.00 (0.86-1.17) 0.98 (0.84-1.14) 1.11 (0.82-1.50) Quartile 1 146 1.04 (0.86-1.24) 1.00 (0.83-1.20) 1.36 (0.98-1.88) P for trend 0.759 0.850 0.648 White American Quartile 4 70 1.0 1.0 1.0 Quartile 3 131 1.23 (0.92-1.65) 1.22 (0.91-1.64) 1.22 (0.91-1.64) Quartile 2 113 1.12 (0.83-1.52) 1.11 (0.82-1.50) 1.11 (0.82-1.50) Quartile 1 102 1.44 (1.05-1.96) 1.43 (1.04-1.95) 1.37 (0.99-1.90) P for trend 0.058 0.071 0.135 African American Quartile 4 616 1.0 1.0 1.0 Quartile 3 178 0.99 (0.83-1.17) 0.96 (0.81-1.14) 0.96 (0.81-1.14) Quartile 2 109 1.06 (0.87-1.30) 1.04 (0.85-1.28) 1.04 (0.85-1.29) Quartile 1 44 0.79 (0.58-1.07) 0.75 (0.55-1.02) 0.75 (0.55-1.03) P for trend 0.462 0.256 0.282 Covariates adjusted in the Cox regression analysis Model 1 : Age at enrollment, enrollment source and Race. Model 2 : Model 1 covariates plus marital status, BMI, age at menarche, parity, menopause status, mammogram ever, history of breast cyst, history of breast cancer in mother and/or sister, Health Eating Index, physical activity level and comorbidity status. Model 3 : Model 2 covariates, plus household income and education status. Statistical significance at 95% confidence interval, p value = 0.05. Table 4 Association of Neighbourhood Deprivation Index (NDI) with breast cancer specific mortality (death) for all races and by race stratification Exposure Deaths (N=218) Model 1 Mode 2 Model 3 aHR (95% CI) aHR (95% CI) aHR (95% CI) ALL Races Quartile 4 118 1.0 1.0 1.0 Quartile 3 44 0.79 (0.56-1.13) 1.12 (0.70-1.78) 1.23 (0.76-1.98) Quartile 2 38 1.04 (0.72-1.50) 1.01 (0.61-1.67) 0.93 (0.55-1.58) Quartile 1 18 0.78 (0.47-1.29) 0.92 (0.45-1.78) 1.13 (0.49-2.60) P for trend 0.493 0.326 0.503 White American Quartile 4 10 1.0 1.0 1.0 Quartile 3 15 0.82 (0.36-1.88) 0.70 (0.24-2.02) 0.71 (0.23-2.14) Quartile 2 19 1.38 (0.62-3.06) 1.58 (0.59-4.24) 1.39 (0.50-3.85) Quartile 1 14 1.11 (0.48-2.59) 1.43 (0.52-3.95) 1.92 (0.62-5.89) P for trend 0.416 0.161 0.090 African American Quartile 4 108 1.0 1.0 1.0 Quartile 3 29 0.90 (0.59-1.36) 1.03 (0.65-1.64) 1.12 (0.71-1.78) Quartile 2 19 1.02 (0.63-1.67) 0.78 (0.44-1.39) 0.76 (0.42-1.38) Quartile 1 * * * * P for trend 0.387 0.155 0.222 Covariates adjusted in the Cox regression analysis Model 1 : Adjusted for age at diagnosis and enrollment source. Model 2 : Adjusted with Model 1 covariates, plus BMI, total physical activity time (MET), comorbidity status and treatment: chemotherapy, surgery and radiotherapy. Model 3 : Adjusted with Model 2 covariates, plus household income and education status. Statistical significance at 95% confidence interval, p value = 0.05. * Number of deaths less than 4, hazards ratios not reported due to participants being less than 10 under the quartile category. Additional Declarations No competing interests reported. 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Shrubsole","email":"","orcid":"","institution":"Vanderbilt University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Martha","middleName":"J.","lastName":"Shrubsole","suffix":""},{"id":541922954,"identity":"72c638f4-d2da-4c9c-bc06-d4c585f5aba7","order_by":5,"name":"Wei Zheng","email":"","orcid":"","institution":"Vanderbilt University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Zheng","suffix":""},{"id":541922955,"identity":"998b9144-ce1a-4b30-a5fe-b058a918b1a3","order_by":6,"name":"Loren Lipworth","email":"","orcid":"","institution":"Vanderbilt University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Loren","middleName":"","lastName":"Lipworth","suffix":""},{"id":541922956,"identity":"dea55b11-ffac-46b5-9cb3-22c875f4bd8a","order_by":7,"name":"Wilbroad Mutale","email":"","orcid":"","institution":"The University of Zambia","correspondingAuthor":false,"prefix":"","firstName":"Wilbroad","middleName":"","lastName":"Mutale","suffix":""},{"id":541922957,"identity":"ed771b84-3690-44ec-9c54-392e6ff66823","order_by":8,"name":"Xiao-Ou Shu","email":"","orcid":"","institution":"Vanderbilt University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Xiao-Ou","middleName":"","lastName":"Shu","suffix":""}],"badges":[],"createdAt":"2025-09-11 20:53:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7594853/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7594853/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":95655060,"identity":"7bbedb6b-7617-4c00-af6a-c1931bba722c","added_by":"auto","created_at":"2025-11-11 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16:15:51","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":218149,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7594853/v1/7c929b0785d3dce254ba8b2d.html"},{"id":95660018,"identity":"73230b69-e001-4eeb-a9c5-09e9c32ae546","added_by":"auto","created_at":"2025-11-11 16:30:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2904746,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7594853/v1/dfd5dc95-7d68-45a3-9e97-5cba97386f94.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association of community-level deprivation with breast cancer risk and survival among women residing in the southeastern United States","fulltext":[{"header":"Introduction","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eBreast cancer is a significant cause of cancer-related morbidity and mortality among women in the United States of America (USA) and worldwide (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Although breast cancer incidence for Black women was lower (127.8 per 100,000) than white women (133.7 per 100,000) in 2023 in the USA, Black women are more likely to die from breast cancer than their white counterparts (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Black or African American women may experience breast cancer disparities, in part, due to the impact of socioeconomic status (SES) at individual, geographical, and societal level (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Literature suggests an association of community-level deprivation, commonly accompanied by unhealthy diet, physical inactivity and limited access to health care, with increased risk of breast cancer incidence and mortality as well as other non-communicable diseases and health-related outcomes (\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). However, explicit evidence is still lacking that defines the association of community-level deprivation with breast cancer risk and mortality along racial lines (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eVarious indices have been adopted to evaluate community-level deprivation based on census tracts and socioeconomic domains of the individual and community (\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Studies that have assessed this relationship between community-level deprivation and various health outcomes found mixed results along racial lines and by individual-level SES (\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). There may exist a parallel of area deprivation with individual socioeconomic status whereby they may have an additive or multiplicative effect on overall breast cancer risk or mortality (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Some of the factors known to be associated with community deprivation are high exposure to alcohol or alcohol abuse, an unhealthy diet and a polluted environment that may have an impact on breast cancer risk and its outcome (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn this study, we evaluated the association between community-level deprivation defined by the neighbourhood deprivation index (NDI) with risk and survival of breast cancer among female participants recruited to the Southern Community Cohort Study (SCCS).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy population\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e Our study included female participants from the Southern Community Cohort Study (SCCS), a large prospective cohort study of predominantly low-income individuals. The SCCS, described in detail elsewhere, enrolled from 2002 to 2009 a total of 84,797 English-speaking women and men between the ages of 40 and 79 from twelve southeastern states in the USA (Alabama, Arkansas, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEighty-six percent (86%) of participants were enrolled from Community Health Centres (CHCs), which serve low-income communities, while 14% came from the general population through mail invitation using an identical validated survey questionnaire, respectively. At CHC, a computer-assisted baseline survey was administered in person to capture individual social demographic, household income, reproductive and gynaecologic history, comorbid conditions, and lifestyle factors. The same survey questionnaire was administered to participants invited via mail, who were selected by stratified random sampling from the general population residing in the states targeted by the study. The Institutional Review Board (IRB) at the Vanderbilt University Medical Center and Meharry Medical College approved the study. All participants provided their written consent for participation according to the Declaration of Helsinki for medical research involving human participants (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The questionnaire used in this study was designed for the SCCS that sought to investigate the unresolved questions about causes of cancer and other chronic diseases. The questionnaire is available at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.southerncommunitystudy.org/questionnaires.html\u003c/span\u003e\u003cspan address=\"https://www.southerncommunitystudy.org/questionnaires.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Our current cohort study included 43,384 female SCCS participants who had never been diagnosed with any malignancy during the year prior to study enrolment except for non-melanoma skin cancer (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eExposure measurement\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eParticipants\u0026rsquo; community-level socioeconomic status was ascertained based on their provided baseline residential address and zip code corresponding to the 2000 community-level census tract data. The neighbourhood deprivation index (NDI), the index used in our study to measure community-level deprivation, was derived from data based on eight 2000 census tract-level variables comprising education level, unemployment rates, managerial jobs, household costs, poverty levels, women-headed households, public assistance households, and owner-occupied homes of a particular community following the algorithm established by Messer et al. 2006 (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The index distribution was categorised into quartiles, with quartile one (Q1) representing the least deprived neighbourhood while quartile four (Q4) represented the most deprived neighbourhood (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eCovariate description\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eStudy participants self-reported their race as White or black American, their highest level of education attained ranging from high school or less, some college and more than a college degree. Their body mass index BMI (kg/m\u003csup\u003e2\u003c/sup\u003e) was calculated based on self-reported height and weight at enrolment. The cutoffs for BMI categories were determined by the following designations: underweight (BMI\u0026thinsp;\u0026lt;\u0026thinsp;18.5), healthy and normal weight (BMI 18.5\u0026ndash;24.9); in our study, we combined Underweight and healthy into a single category. Overweight (BMI 25\u0026ndash;\u0026lt;30), and obese 1 (BMI 30-\u0026lt;35.0) and obese 2/3 according to CDC guidelines. Dietary intake was assessed using 89-item food frequency questionnaire variables developed specifically for a typical diet in the southeastern United States and validated with respect to nutrient intakes (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Diet quality was evaluated using the Healthy Eating Index 2010 (HEI10) based on self-reported food frequency intake data to derive individual scores with a maximum score of 100 (range from 0 -100). The SCCS food frequency quartile data were linked to the United States Department of Agriculture (USDA) MyPyramid equivalents database to generate corresponding intakes for HEI food groups and calculate 12 components scores utilising the SAS code provided by the USDA. The derived quartiles for HEI10 were then assigned to each participant; the lowest quartile represents food intake poorly aligned to guidelines, while the highest quartile represents food intake most aligned to the USDGA (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe total physical activity time for the participants was assessed using the SCCS Physical Activity Questionnaire (SCCS PAQ) based on several validated survey tools (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). The questionnaire evaluated a wide range of individual activities variables, including active and sedentary habits typically done at home, work, and during leisure time. Duration reports of active behaviours (hours/day) were converted to estimates (scores) of physical activity (PA) energy expenditure using Metabolic equivalent time (MET) hours/day) for specific activities assessed using the Compendium of Physical Activities (CAP). Participants\u0026rsquo; co-morbidity score designed from the Charlson Co-morbidity Index (CCI) was developed empirically based on risk factors that predicted 1-year mortality. The index is based on numeric values ranging from 0 to 12, categorised as \u0026ldquo;0\u0026rdquo;, \u0026ldquo;1\u0026ndash;3\u0026rdquo;, and 4+, with 0 having no comorbid conditions and 4\u0026thinsp;+\u0026thinsp;with most comorbid conditions associated with increased 1-year mortality (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). All these variables were collected during the baseline survey.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eOutcome measurement\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eParticipants were followed through December 31, 2019, for incident breast cancer and survival through linkages with state and national registers. Participants\u0026rsquo; breast cancer diagnoses were ascertained through linkage with the population-based Cancer registry from the 12 southeastern states, while vital statistics information was collected via linkage with the National Death Index (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Incident breast cancer and breast cancer-specific mortality were ascertained by ICD-10, C50.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eParticipants\u0026rsquo; descriptive statistics by breast cancer occurrence or breast cancer-specific death for categorical baseline characteristics were reported in percentages, and comparisons were evaluated using the Pearson chi-square test for categorical variables. Continuous variables were summarised using median and interquartile range (IQR), and comparisons were conducted using Student t-test, analysis of variance (ANOVA) or Mann-Whitney (Wilcoxon Rank) statistical test. Time-to-event evaluation was performed using Kaplan-Meier survival analysis to estimate the probability of breast cancer risk (incidence case) and breast cancer-specific survival among study participants across NDI quartiles and by race stratification. Time interval references were calculated in months, for breast cancer incidence defined as months from enrollment to breast cancer diagnosis and end of follow-up for breast cancer incidence models while time for breast cancer survival models was defined as time in months from breast cancer diagnosis to death (for breast cancer-specific mortality analysis only) or end of follow-up. Variation in breast cancer risk and survival across levels of community-level deprivation and race was assessed using the log-rank test.\u003c/p\u003e\u003cp\u003eCox regression analyses were carried out to estimate hazard ratios and 95% confidence intervals for breast cancer risk, as well as total or breast cancer-specific mortality for association with NDI, while adjusting for potential confounders. The covariates adjusted in regression analyses are age at enrolment (for risk analysis), age at diagnosis (for mortality analysis), enrollment method, race (Black and white), age at menarche, menopause status, history of breast cyst, history of breast cancer in mother and sister, mammography screening, age at first birth, parity, body mass index (BMI), health eating index (HEI), physical activity, co-morbidity status, household income. For survival analyses, age at diagnosis, enrollment source (model 1), plus BMI, total physical activity time (MET), comorbidity status treatment variables: chemotherapy, surgery and radiotherapy (Model 2), plus household income and education status (Model 3) (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). We applied nested models to assess potential confounding effects of reproductive, lifestyle, clinical variables, and individual-level socioeconomic factors.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eMultiple imputation using chained equation using R package: (MICE), M\u0026thinsp;=\u0026thinsp;1, was conducted to account for missing data of missing values at random (0.3%\u0026ndash;5.8%). All analyses were performed using STATA version 17(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). A two-sided test was used, and all p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe current study included 43,384 women with a median age of 51 years interquartile range (IQR)\u0026nbsp;13.0\u0026nbsp;years\u0026nbsp;at\u0026nbsp;baseline;\u0026nbsp;69.2%\u0026nbsp;were\u0026nbsp;black\u0026nbsp;and\u0026nbsp;30.8%\u0026nbsp;white.\u0026nbsp;After\u0026nbsp;a\u0026nbsp;median\u0026nbsp;follow-up\u0026nbsp;of\u003c/p\u003e\n\u003cp\u003e12.8 (IQR 3.8) years, 1,363 women developed incident breast cancer, and 365 of them died subsequently, with 218 deaths resulting from breast cancer-specific causes. Median age at the time of death was 62.0 (IQR 15) years for breast cancer-specific mortality and 69.0 (IQR 12) years for death from other causes among those who developed incident breast cancer; however, the difference did not reach statistical significance (p = 0.69). \u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003epresents a summary of descriptive characteristics of study participants by breast cancer incidence (risk) and breast cancer-specific mortality status. Overall, participants who developed breast cancer were more likely\u0026nbsp;to\u0026nbsp;be\u0026nbsp;enrolled\u0026nbsp;from\u0026nbsp;the\u0026nbsp;general\u0026nbsp;population\u0026nbsp;than\u0026nbsp;CHC\u0026nbsp;(p\u0026nbsp;\u0026lt;\u0026nbsp;0.05),\u0026nbsp;to\u0026nbsp;report\u0026nbsp;some\u0026nbsp;college\u0026nbsp;or higher educational level status (p \u0026lt; 0.05), to be widowed (p \u0026lt; 0.001), and to be obese (BMI\u0026gt;=30) (p \u0026lt; 0.05). Other individual characteristics that differed significantly between participants who developed breast cancer compared to those who did not were post-menopause status, having a mammogram, a history of breast cysts, a history of breast cancer in mother or sister, with healthy eating index 10 quartile three (Q 3) and a co-morbidity score of 1-3. No significant differences were observed between the proportions of women who developed breast cancer\u0026nbsp;and\u0026nbsp;those\u0026nbsp;who\u0026nbsp;did\u0026nbsp;not\u0026nbsp;for\u0026nbsp;participants\u0026rsquo;\u0026nbsp;age\u0026nbsp;at\u0026nbsp;enrolment,\u0026nbsp;race,\u0026nbsp;household\u0026nbsp;income,\u0026nbsp;age category at menarche, age at first birth, parity category and total physical activity time.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA comparison between those who died from breast cancer-specific causes and the survivor\u0026rsquo;s household income, marital status, menopausal status, mammogram ever, breast cyst history and comorbid score showed a statistically significant difference between the two groups (p \u0026lt; 0.05). On the contrary, enrolment source, race, education attainment, body mass index, the age category of menarche, age at first birth, parity category, and history of breast cancer in mother and sister showed no significant differences between the survivors and those who died from breast cancer- specific cause. In addition, the age at enrolment of the participants was not statistically significantly different between those who died of breast cancer-specific causes compared to those who survived or died from other causes, p = 0.506.\u003c/p\u003e\n\u003cp\u003eThe baseline characteristics of study participants, as determined by the NDI quartile distribution, are shown in Table 2. Overall, participants who lived in different community-level deprivations showed a statistically significant difference in descriptive variables, including age at enrolment (for risk analysis), enrolment source, race (Black and white), age at menarche, menopause status, history of breast cyst, history of breast cancer in mother and sister, mammography screening, age at first birth, parity, BMI, HEI, physical activity, co-morbidity status and household income during mortality analyses. Only participants\u0026rsquo; age at cancer diagnosis, age at death for breast cancer specific mortality, tumour stage and immunohistochemistry surrogate for tumour molecular classification did not reach statistically significant difference across the NDI quartiles (p \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003eTime-to-event analysis showed no significant difference in breast cancer risk for all participants across NDI and by race stratification (log-rank tests p value = 0.65 and p value = 0.46), respectively. Cox regression analysis for NDI association with breast cancer risk regardless of model covariates adjustments for unstratified race was non-significant, while analysis stratified by race showed that NDI was statistically significantly associated with breast cancer risk among White women: residing in the least deprived neighbourhood communities increased risk of breast cancer by 44% in the minimally adjusted; model 1 (adjusted hazard ratio (aHR)=1.44, 95% CI; 1.05-1.96); model 2 additionally adjusted for known breast cancer risk factors (aHR=1.43, 95% CI; 1.04-1.95) and with attenuation in Model 3 after adjusting for individual level of SES, household income and education status (aHR =1.37, 95% CI; 0.99-1.90). In contrast, no statistically significant association of NDI with breast cancer risk was found among Black American women, as shown in \u003cstrong\u003eTable 3\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eOverall, breast cancer-specific survival using Kaplan-Meier analysis did not show any statistically significant difference across participants\u0026rsquo; NDI categories among White and Black breast cancer patients (p value = 0.33 and p value = 0.14), respectively\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eMultivariate analyses showed no statistically significant association between NDI and breast cancer-specific mortality among either White or Black in all models. The fully adjusted HR was 1.07 (95% CI; 0.36 - 3.18) for white patients and 0.79 (95% CI; 0.31- 1.10) for black patients residing in the least deprived communities, as shown in \u003cstrong\u003eTable 4\u003c/strong\u003e. Similar null associations were found for total mortality (data not shown).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIn this large prospective cohort study, carried out among the residents of the southeastern states of the USA with predominately low household income, we found that white women living in the least deprived communities had an increased breast cancer risk compared to those living in neighbourhoods with high deprivation. This association persisted after adjustments for participant demographic, known breast cancer risk factors, reproductive and lifestyle factors, as well as individual levels of socioeconomic status. On the contrary, we found no significant association between NDI and breast cancer risk among Black women. No association was found between NDI and mortality after diagnosis of breast cancer among both white and black women. Breast cancer has been considered a disease of the affluent, with possible risk factors arising from delayed childbirth, less breast-feeding and use of hormone supplements practices that are commonly found among affluent women (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Studies on breast cancer outcomes comparing risk and survival report a higher incidence of breast cancer occurrence among non-Hispanic White American women than non-Hispanic Black American women, while survival is lower among non-Hispanic Black women (\u003cspan additionalcitationids=\"CR33 CR34\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Black women are 40% more likely to die from breast cancer compared to White women, while the survival of Black women has also been noted to be consistently 10 percentage points lower than that for White women, and this disparity has persisted over time/ decades (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePrevious studies have shown that community-level deprivation may be associated with increased cancer mortality in racially diverse communities (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Studies have shown that the black population and those residing in deprived communities tend to have poor health outcomes (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Eley et al., 1994, showed approximately 75% of the racial difference in survival was explained by sociodemographic variables at an individual level that appeared to act largely through racial differences in stage at diagnosis. In their study, after adjusting for geographic site and age, black participants remained at greater risk of dying at 2.2 times (95% CI; 1.8\u0026ndash;2.8) than whites (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Evidence on the association of cancer incidence and health outcomes with area-level deprivation in various parts of the globe tends to support community-level deprivation with increased risk of poor health outcomes such as non-communicable diseases, cancer and mortality (\u003cspan additionalcitationids=\"CR43\" citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). The multifactorial interplay of these neighbourhood environments and health behaviour factors may lead to additive or multiplicative effects, resulting in individuals residing in the most deprived communities experiencing increased risk and resulting in worse individual and community-level health outcomes (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOne of the mechanisms whereby neighbourhood socioeconomic environment may influence health outcomes is that disadvantaged neighbourhoods position individuals in conditions that may lead to unhealthy behaviours such as consuming unhealthy products such as alcohol, energy-dense foods resulting in obesity, and tobacco smoking (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). Disparities in access to health care services may also significantly contribute to poor health outcomes in deprived communities. Individuals with low socioeconomic status tend to live in communities with limited healthcare facilities, poor health-seeking behaviour and limited financial resources to seek care (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). In the USA, white women in general, have a higher breast incidence than black women, but black women experience higher mortality than their white counterparts (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). While some studies have found a smaller racial disparity in breast cancer when individual level of socioeconomic status was considered, disparities in incidence and survival among Black women persist (\u003cspan additionalcitationids=\"CR49\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOur finding of white women residing in the least deprived communities had an increased risk of breast cancer is in line with the risk difference noted in the general population. Our study's failure to establish an association of community-level deprivation with the risk of developing breast cancer among SCCS Black women and death from breast cancer after diagnosis for White and Black women disagrees with some of the previous reports. The most significant difference between our study and previous studies is that our study participants, both Black and White women, were predominantly (86%) recruited from community healthcare facilities that provide services to individuals from communities with socioeconomic challenges (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e). Therefore, White and Black women participants of our study have similar socioeconomic background and comparable access to health care. Our study suggests that when individual level of SES and access to health are held constant, the NDI is no longer a significant contributor to breast cancer disparities.\u003c/p\u003e\u003cp\u003eThe strengths of our study include prospective study design, inclusion of a large Black women population and low-income study participants and ability to adjust for individual-level SES and various lifestyle factors. However, our study population's relatively homogenous SES background may reduce the statistical power to detect small health effects associated with NDI. Future research on this topic should include individuals with a broad SES spectrum.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWe found white women residing in the least deprived communities had an increased risk for breast cancer but not for mortality after breast cancer diagnosis. Neighbourhood deprivation index was not associated with breast cancer risk of breast cancer-specific mortality among Black women. This study indicates that community-level deprivation plays no major role in breast cancer risk and mortality disparity when individual level of SES and access to health care are accounted for.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eSCCS Southern community cohort study \u003c/p\u003e\n\u003cp\u003eNDI Neighbourhood deprivation index\u003c/p\u003e\n\u003cp\u003eBC Breast cancer \u003c/p\u003e\n\u003cp\u003eCI Confidence interval \u003c/p\u003e\n\u003cp\u003eHR Hazards ratio \u003c/p\u003e\n\u003cp\u003eSES Socioeconomic status \u003c/p\u003e\n\u003cp\u003eUSA United States of America\u003c/p\u003e\n\u003cp\u003eANOVA Analysis of variance\u003c/p\u003e\n\u003cp\u003eBMI Body mass index\u003c/p\u003e\n\u003cp\u003eHEI Health eating index\u003c/p\u003e\n\u003cp\u003eMET Metabolic turnover time\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all the participants and the principal investigators for the Southern Community Cohort Study (SCCS), Dr Wei Zheng and \u003cstrong\u003eDr Martha Shrubsole\u0026nbsp;\u003c/strong\u003eat Vanderbilt University Medical Centre (VUMC), for their support in realising this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing of interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ea. Ethics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the institutional review boards of Vanderbilt University and the Meharry Medical College, and participants gave voluntary written informed consent at study enrolment aligning with the Declaration of Helsinki and publication of anonymised research findings. The study\u0026rsquo;s general objectives, risks of the Southern Community Cohort Study, and long-term follow-up were explained to the participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb. \u0026nbsp; \u0026nbsp;Consent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author hereby confirms consent for the publication of the results in this manuscript with the accompanying data from the individual participants enrolled. The participant\u0026apos;s informed consent included publication of the anonymised individual participants\u0026rsquo; information detailed in the manuscript to be available and accessible to the public.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ec. \u0026nbsp; \u0026nbsp;Availability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData availability described in the manuscript, codebook, and analytic code will be made available upon request after the investigator has obtained approval from the ethics committee and data sharing committee of the SCCS. Requests for data are to be made at www.southerncommunitystudy.org.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ed. \u0026nbsp; \u0026nbsp;Competing interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ee. \u0026nbsp; \u0026nbsp;Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research reported in this publication was supported by the National Cancer Institute (NCI) of the US National Institutes of Health (NIH) under the Award Number D43CA270474 and in partial by research funding from the Pfizer, Inc. The SCCS was supported by NCI grants (R01CA092447 and U01CA202979). The funding agencies have no role in data analysis and interpretation. The contents of the publication are the sole responsibility of the authors and don\u0026rsquo;t necessarily reflect the official views of the NCI and NIH.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ef. \u0026nbsp; \u0026nbsp;Authors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe following were the contributions of authors: Study conceptualisation:\u0026nbsp;K.M\u003csup\u003e1\u003c/sup\u003e.,\u0026nbsp;R.F\u003csup\u003e2\u003c/sup\u003e.,\u0026nbsp;and\u0026nbsp;X.S\u003csup\u003e4\u003c/sup\u003e.;\u0026nbsp;study methodology:\u0026nbsp;K.M\u003csup\u003e1\u003c/sup\u003e.,\u0026nbsp;R.F\u003csup\u003e2\u003c/sup\u003e.,\u0026nbsp;and\u0026nbsp;X.S\u003csup\u003e4\u003c/sup\u003e.;\u0026nbsp;data\u0026nbsp;analysis:\u0026nbsp;K.M\u003csup\u003e1\u003c/sup\u003e., R.F\u003csup\u003e2\u003c/sup\u003e., L.L\u003csup\u003e4\u003c/sup\u003e., M.J.S\u003csup\u003e4\u003c/sup\u003e., and X.S\u003csup\u003e4\u003c/sup\u003e.; manuscript writing\u0026nbsp;and editing: K.M\u003csup\u003e1\u003c/sup\u003e., X.S\u003csup\u003e4\u003c/sup\u003e.,\u0026nbsp;V.K\u003csup\u003e3\u003c/sup\u003e.,\u0026nbsp;W.M\u003csup\u003e5\u003c/sup\u003e.,\u0026nbsp;J.P\u003csup\u003e4\u003c/sup\u003e.,\u0026nbsp;X.S\u003csup\u003e4\u003c/sup\u003e., L.L\u003csup\u003e4\u003c/sup\u003e.,\u0026nbsp;M.J.S\u003csup\u003e4\u003c/sup\u003e., and\u0026nbsp;W.Z\u003csup\u003e4\u003c/sup\u003e.; additional SCCS resources: investigators X.S\u003csup\u003e4\u003c/sup\u003e., L.L\u003csup\u003e4\u003c/sup\u003e., M.J.S\u003csup\u003e4\u003c/sup\u003e., and W.Z\u003csup\u003e4\u003c/sup\u003e. All authors reviewed and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e1Department of Surgical Oncology, Cancer Diseases Hospital and Department of Epidemiology \u0026amp; Biostatistics, School of Public Health, The University of Zambia, Lusaka Zambia.\u003c/p\u003e\n\u003cp\u003e2Department of Epidemiology \u0026amp; Biostatistics, School of Public Health, The University of Zambia, Lusaka, Zambia.\u003c/p\u003e\n\u003cp\u003e3Department of Internal Medicine, School of Medicine, The University of Zambia, Lusaka Zambia.\u003c/p\u003e\n\u003cp\u003e4Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville TN, USA.\u003c/p\u003e\n\u003cp\u003e5Department of Health Policy and Management, School of Public Health, The University of Zambia, Lusaka Zambia.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. 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Breast Cancer Res Treat. 1989 Oct;13(3):205\u0026ndash;23. \u003c/li\u003e\n\u003cli\u003eStataCorp. Stata Statistical Software: Release 17. College Station, TX: StataCorp LLC; 2021. \u003c/li\u003e\n\u003cli\u003eMadigan MP, Ziegler RG, Benichou J, Byrne C, Hoover RN. Proportion of Breast Cancer Cases in the United States Explained by Well-Established Risk Factors. JNCI: Journal of the National Cancer Institute [Internet]. 1995 Nov 15 [cited 2023 Nov 26];87(22):1681\u0026ndash;5. Available from: https://dx.doi.org/10.1093/jnci/87.22.1681\u003c/li\u003e\n\u003cli\u003eIqbal J, Ginsburg O, Rochon PA, Sun P, Narod SA. Differences in breast cancer stage at diagnosis and cancer-specific survival by race and ethnicity in the United States. JAMA - Journal of the American Medical Association. 2015 Jan 13;313(2):165\u0026ndash;73. \u003c/li\u003e\n\u003cli\u003eRobert SA, Strombom I, Trentham-Dietz A, Hampton JM, McElroy JA, Newcomb PA, et al. Socioeconomic risk factors for breast cancer: distinguishing individual- and community-level effects. Epidemiology [Internet]. 2004 Jul [cited 2025 Apr 1];15(4):442\u0026ndash;50. Available from: https://pubmed.ncbi.nlm.nih.gov/15232405/\u003c/li\u003e\n\u003cli\u003eKong X, Liu Z, Cheng R, Sun L, Huang S, Fang Y, et al. Variation in Breast Cancer Subtype Incidence and Distribution by Race/Ethnicity in the United States From 2010 to 2015. JAMA Netw Open [Internet]. 2020 Oct 19 [cited 2025 Apr 2];3(10):E2020303. Available from: https://pubmed.ncbi.nlm.nih.gov/33074325/\u003c/li\u003e\n\u003cli\u003eBarber LE, Maliniak ML, Moubadder L, Johnson DA, Miller-Kleinhenz JM, Switchenko JM, et al. Neighborhood Deprivation and Breast Cancer Mortality Among Black and White Women. JAMA Netw Open [Internet]. 2024 Jun 12 [cited 2025 Apr 1];7(6):e2416499. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11170302/\u003c/li\u003e\n\u003cli\u003eMiller JW, Smith JL, Ryerson AB, Tucker TC, Allemani C. Disparities in breast cancer survival in the United States (2001-2009): Findings from the CONCORD-2 study. Cancer [Internet]. 2017 Dec 15 [cited 2025 Apr 2];123 Suppl 24(Suppl 24):5100\u0026ndash;18. Available from: https://pubmed.ncbi.nlm.nih.gov/29205311/\u003c/li\u003e\n\u003cli\u003eSingh GK, Claire Lin CC. Area deprivation and inequalities in health and health care outcomes. Ann Intern Med. 2019 Jul 16;171(2):131\u0026ndash;2. \u003c/li\u003e\n\u003cli\u003eSnider NG, Hastert TA, Nair M, Kc M, Ruterbusch JJ, Schwartz AG, et al. Area-level Socioeconomic Disadvantage and Cancer Survival in Metropolitan Detroit. Cancer Epidemiol Biomarkers Prev [Internet]. 2023 Mar 1 [cited 2023 Sep 12];32(3):387\u0026ndash;97. Available from: https://pubmed.ncbi.nlm.nih.gov/36723416/\u003c/li\u003e\n\u003cli\u003eTzenios N. The Determinants of Access to Healthcare: A Review of Individual, Structural, and Systemic Factors. Journal of Humanities and Applied Science Research [Internet]. 2019 Dec 9 [cited 2025 Feb 2];2(1):1\u0026ndash;14. Available from: https://journals.sagescience.org/index.php/JHASR/article/view/23\u003c/li\u003e\n\u003cli\u003eDeng K, Xu M, Sahinoz M, Cai Q, Shrubsole MJ, Lipworth L, et al. Associations of neighborhood sociodemographic environment with mortality and circulating metabolites among low-income black and white adults living in the southeastern United States. BMC Med [Internet]. 2024 Dec 1 [cited 2025 Sep 16];22(1). Available from: https://pubmed.ncbi.nlm.nih.gov/38886716/\u003c/li\u003e\n\u003cli\u003eEley JW, Hill HA, Greenberg RS, Coates RJ, Chen VW, Correa P, et al. Racial Differences in Survival From Breast Cancer: Results of the National Cancer Institute Black/White Cancer Survival Study. JAMA [Internet]. 1994 Sep 28 [cited 2023 Nov 26];272(12):947\u0026ndash;54. Available from: https://jamanetwork.com/journals/jama/fullarticle/379683\u003c/li\u003e\n\u003cli\u003eHastert TA, Beresford SAA, Sheppard L, White E. Disparities in cancer incidence and mortality by area-level socioeconomic status: A multilevel analysis. J Epidemiol Community Health (1978). 2015;69(2):168\u0026ndash;76. \u003c/li\u003e\n\u003cli\u003eLuce D, Michel S, Dugas J, Bhakkan B, Menvielle G, Joachim C, et al. Disparities in cancer incidence by area-level socioeconomic status in the French West Indies. Cancer Causes and Control [Internet]. 2017 Nov 1 [cited 2023 Nov 26];28(11):1305\u0026ndash;12. Available from: https://link.springer.com/article/10.1007/s10552-017-0946-3\u003c/li\u003e\n\u003cli\u003ePurrington KS, Hastert TA, Madhav KC, Nair M, Snider N, Ruterbusch JJ, et al. The role of area-level socioeconomic disadvantage in racial disparities in cancer incidence in metropolitan Detroit. Cancer Med. 2023 Jul 1; \u003c/li\u003e\n\u003cli\u003eChaparro MP, Benzeval M, Richardson E, Mitchell R. Neighborhood deprivation and biomarkers of health in Britain: The mediating role of the physical environment. BMC Public Health [Internet]. 2018 Jun 27 [cited 2025 Jan 30];18(1):1\u0026ndash;13. Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5667-3\u003c/li\u003e\n\u003cli\u003eFakhri N, Chad MA, Lahkim M, Houari A, Dehbi H, Belmouden A, et al. Risk factors for breast cancer in women: an update review. Med Oncol [Internet]. 2022 Dec 1 [cited 2023 Sep 15];39(12). Available from: https://pubmed.ncbi.nlm.nih.gov/36071255/\u003c/li\u003e\n\u003cli\u003eWalker B, Pollard E, Howard SP, Jones VM, O\u0026rsquo;Connor KL, Durbin EB, et al. The Role of Race/Ethnicity on the Association between Neighborhood Deprivation and Breast Cancer Outcomes among Kentucky Breast Cancer Patients years 2010-2022. Cancer Epidemiology, Biomarkers \u0026amp; Prevention [Internet]. 2025 Jan 21 [cited 2025 Feb 3]; Available from: /cebp/article/doi/10.1158/1055-9965.EPI-24-1139/751174/The-Role-of-Race-Ethnicity-on-the-Association\u003c/li\u003e\n\u003cli\u003eKrieger N. Defining and investigating social disparities in cancer: critical issues. Cancer Causes \u0026amp; Control 2005 16:1 [Internet]. 2005 Feb [cited 2025 Feb 3];16(1):5\u0026ndash;14. Available from: https://link.springer.com/article/10.1007/s10552-004-1251-5\u003c/li\u003e\n\u003cli\u003eDunn BK, Agurs-Collins T, Browne D, Lubet R, Johnson KA. Health disparities in breast cancer: Biology meets socioeconomic status. Breast Cancer Res Treat. 2010 Jun;121(2):281\u0026ndash;92. \u003c/li\u003e\n\u003cli\u003eDeSantis CE, Fedewa SA, Goding Sauer A, Kramer JL, Smith RA, Jemal A. Breast cancer statistics, 2015: Convergence of incidence rates between black and white women. CA Cancer J Clin. 2016 Jan;66(1):31\u0026ndash;42. \u003c/li\u003e\n\u003cli\u003eStafford M, Marmot M. Neighbourhood deprivation and health: Does it affect us all equally? Int J Epidemiol. 2003;32(3):357\u0026ndash;66. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 931px;\"\u003e\n \u003cp\u003eTable 1 Descriptive characteristics for SCCS women participants by breast cancer incidence (risk) and breast cancer specific mortality (N=43,384)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eExposure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eBreast Cancer Incidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eBreast Cancer Specific mortality \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"40\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=42,021)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=1,363)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n = 1,128)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n = 218)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"29\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAge at enrollment, years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51.0(13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e54.0 (13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e**\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e54.0 (13.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e53.0 (13.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.783**\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEnrolment source\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCommunity Health Center (CHC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e37,272 (88.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,168 (87.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e960 (85.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e192 (88.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGeneral Population\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e4,749 (11.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e195 (14.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e168 (14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26 (11.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRace\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWhite American \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12,956 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e416 (30.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.806\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e357 (85.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e58 (26.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAfrican/Black America \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29, 065 (69.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e947 (69.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e771 (14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e160 (73.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEducation status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHigh School or Less\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e28,208 (65.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e878 (67.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.036\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e713 (63.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e151 (69.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSome college or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e13,813 (31.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e485 (33.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e415 (36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e67 (30.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold Income category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;$15,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e23,274 (56.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e729 (54.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e582 (52.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e134 (63.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e$15,000 - \u0026lt;$25,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9,176 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e290 (21.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e243 (21.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e44 (20.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e$25,000+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8,950 (21.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e321 (24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e286 (25.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e34 (16.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e13,915 (33.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e451 (33.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e393 (34.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e54 (24.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e14,292 (34.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e449 (32.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e369 (32.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e74 (33.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e5,659 (13.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e240 (17.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e195 (17.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e41 (18.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNever married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e8,155 (19.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e223 (16.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e171 (15.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e49 (22.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBody mass index (BMI)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eUnderweight/healthy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e8,246 (19.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e214 (15.7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e172 (15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40 (18.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.459\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOverweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e10,629 (25.3)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e346 (25.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e281 (24.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e57 (26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eObese (class 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e10,467 (24.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e362 (26.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e299 (26.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e59 (27.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eObese (class 2 and 3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e12,679 (30.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e441 (32.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e376 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e62 (28.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAge category of menarche (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;=11 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8,926 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e295 (21.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.721\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e939 (83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e190 (87.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.356\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026gt; 11 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33,095 (78.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1,068 (78.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e189 (16.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28 (12.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAge at first birth (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;=18 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15,649 (37.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e488 (35.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.557\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e403 (35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e79 (36.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.828\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e19-34 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21,389 (59.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e709 (52.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e584 (51.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e115 (52.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNone or 35+ \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4,983 (11.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e166 (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e141 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24 (11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eParity category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNulliparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4,371 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e146 (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.653\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e122 (10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e23 (10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.532\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6,045 (14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e185 (13.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e150 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34 (15.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10,943 (26.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e343 (25.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e291 (25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e47 (21.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e3+ \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20,662 (49.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e689 (50.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e565 (50.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e114 (52.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMenopause status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e13,810 (32.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e364 (26.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e287 (25.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e74 (33.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.009\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e28,211 (67.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e999 (73.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e841 (74.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e144 (66.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMammogram ever\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e6,921 (16.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e149 (10.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e115 (10.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e33 (15.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.033\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e35,100 (83.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1214 (89.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1013 (89.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e185 (84.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBreast cyst history\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e35,637 (84.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,027 (75.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e835 (74.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e180 (82.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e6,384 (15.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e336 (24.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e293 (26.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e38 (17.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003c/strong\u003e\u003cstrong\u003eBreast cancer in mother or sister\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e37,844 (90.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1143 (83.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e939 (83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e190 (87.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e4,177 (9.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e220 (16.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e189 (16.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28 (12.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eHealthy Eating Index 10 Quarter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMean (SD\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e59.4 (11.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e61.1 (11.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e61.5 (11.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e59.6 (11.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.023*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Physical Activity Time\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17.2 (17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17.2 (17.7)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.188**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e17.2 (16.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e14.1 (17.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCo-morbidity score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e6,554 (15.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e164 (12.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e130 (11.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e33 (15.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.018\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"20\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e1 to 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e30,453 (72.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,036 (76.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e871 (77.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e149 (68.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"21\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e4+ \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e5,014 (11.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e163 (12.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e127 (11.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e36 (16.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"17\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" rowspan=\"2\"\u003e\n \u003cp\u003eStatistical test: Student t-test*, Mann-Whitney (Wilcoxon Rank) ** test for continuous variables and Pearson chi2 for categorical variables, statistical significance at 95 confidence interval, p value = 0.05.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"33\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd height=\"33\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2 Baseline characteristics of study participants by neighbourhood deprivation index (NDI) quartile distribution (N=43,384)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eArea Deprivation Index (NDI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eExposure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eQuartile 1 (n=4310)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eQuartile 2 (n=7101)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eQuartile 3 (n=9474)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eQuartile 4 (n=22499)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEnrolment Age, years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e52 (13)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e51 (13)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e52 (12)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e50 (12)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAge at cancer diagnosis, years (n =1363)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e62 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e61 (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e61 (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e60 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.066**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAge at death, years (breast cancer-specific mortality n = 218)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e62.0 (15.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e60.0 (16.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e63.0 (13.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e61.5 (13.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.115**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEnrolment source\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCommunity Health Center\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e3,276 (76)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e6,021 (84.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e8,193 (86.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e20,950 (93.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGeneral Population\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,034 (24)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,080 (15.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,281 (13.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,549 (6.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRace\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWhite American \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2,624 (60.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e3,902 (55.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e4,036 (42.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2,810 (12.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBlack America \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,686 (39.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e3,199 (45.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e5,438 (57.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e19,689 (87.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIncome category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;$15,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,475 (35.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e3,267 (46.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e4,914 (52.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e14,347 (21.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e$15,000 to \u0026lt;$25,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e752 (17.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,631 (23.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2,222 (23.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e4,861 (21.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e$25,000+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,992 (47.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2,094 (30.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2,186 (23.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2,999 (13.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEducation status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHigh school or less\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,953 (62.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e4,467 (62.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e6,383 (67.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e16,283 (72.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSome college or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2,357 (54.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2,634 (37.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e3,091 (32.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e6,216 (27.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,878 (43.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2,959 (41.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e3,656 (38.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e5,873 (26.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,459 (33.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2,313 (32.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e3,157 (33.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e7,812 (34.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e445 (10.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e887 (12.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,308 (13.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e3,259 (14.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNever married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e528 (12.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e942 (13.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,353 (14.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e5,555 (24.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMammogram ever\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e423 (9.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,022 (14.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,293 (13.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e4,332 (19.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e3,887 (90.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e6,079 (85.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e8,181 (86.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e18,167 (80.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBreast cyst history\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e3,345 (77.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e5,792 (81.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e7,886 (83.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e19,641 (87.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e965 (22.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,309 (18.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,588 (16.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2,858 (12.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAge Category of menarche\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;=11\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e937 (21.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,618 (22.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2,079 (21.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e4,587 (20.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026gt; 11\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e3,373 (78.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e5,483 (77.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e7,395 (78.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e17,912 (79.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAge at first birth (35+), years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;=18\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,044 (24.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2,271 (32.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e3,247 (34.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e9,575 (42.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e19-34\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2,532 (58.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e3,933 (55.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e5,180 (54.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e10,453 (46.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNone or 35+\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e734 (17.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e897 (12.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,047 (11.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2,471 (11.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eParity category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNulliparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e625 (14.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e777 (10.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e936 (9.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2,179 (9.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e674 (15.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,069 (15.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,364 (14.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e3,123 (13.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,383 (32.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2,136 30.1)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2,614 (27.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e5,153 (22.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e3+\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,628 (37.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e3,119 (43.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e4,560 (48.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e12,044 (53.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMenopause status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,315 (30.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2,180 (30.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2,727 (28.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e7,952 (35.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2,995 (69.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e4,921 (69.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e6,747 (71.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e14,547 (64.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003c/strong\u003e\u003cstrong\u003eBreast cancer in mother or sister\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e3,813 (88.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e6,358 (89.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e8,468 (89.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e20,348 (90.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e497 (11.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e743 (10.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,006 (10.6)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2,151 (9.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eHealthy Eating Index 10 Quarter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMean, SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e62.5 (12.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e59.6 (11.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e59.6 (11.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e58.7 (11.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Physical Activity Time\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMedian, (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e17.2 (16.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e17.4 (18.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e17.2 (17.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e17.2 (17.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAJCC Group Stage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50 (46.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e69 (41.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e115 (48.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e174 (36.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36 (18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e54 (32.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e72 (30.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e194 (40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33 (19.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35 (14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e77 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4 (3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13 (5.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e31 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBreast Cancer Molecular Subtype\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eER+ and/or PR+/HER2-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e77 (52.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e107 (48.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e152 (29.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e312 (45.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHER2+/ER+ and/or PR+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13 (8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e23 (10.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e56 (8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eER-/PR-/HER2+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6 (4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6 (2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21 (6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38 (5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eER-/PR-/HER2-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13 (8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24 (10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40 (12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e121 (17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e37 (25.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e62 (27.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e76 (24.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e159 (23.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCo-morbidity score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e810 (18.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,111 (15.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,390 (14.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e3,407 (15.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e1-3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e3,132 (72.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e5,150 (72.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e6,910 (72.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e16,297 (72.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e4+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e368 (8.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e840 (11.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1,174 (12.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2,795 (12.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e\n \u003cp\u003eStatistical test: ANOVA*, Mann-Whitney (Wilcoxon Rank) ** test for continuous variables and Pearson chi2 for categorical variables, statistical significance\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eat 95 confidence interval, p value = 0.05. AJCC American Joint Committee on Cancer, ER estrogen receptor, PR progesterone receptors, HER2 human epidermal growth factor-2 receptor.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 Association of neighbourhood deprivation index (NDI) with breast cancer risk for all races and by race stratification\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExposure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCases (N=1,347)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMode 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eaHR\u0026nbsp;(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eaHR\u0026nbsp;(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eaHR\u0026nbsp;(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eALL\u0026nbsp;Races\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eQuartile 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e686\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eQuartile 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e309\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e1.02 (0.89-1.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e0.99 (0.87-1.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e1.22 (0.91-1.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eQuartile 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e1.00 (0.86-1.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e0.98 (0.84-1.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e1.11 (0.82-1.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eQuartile 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e1.04 (0.86-1.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e1.00 (0.83-1.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e1.36 (0.98-1.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eP\u0026nbsp;for trend\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e0.759\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e0.850\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e0.648\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhite American\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eQuartile 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eQuartile 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e1.23 (0.92-1.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e1.22 (0.91-1.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e1.22 (0.91-1.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eQuartile 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e1.12 (0.83-1.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e1.11 (0.82-1.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e1.11 (0.82-1.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eQuartile 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.44 (1.05-1.96)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.43 (1.04-1.95)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e1.37 (0.99-1.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eP\u0026nbsp;for trend\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e0.135\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAfrican\u0026nbsp;American\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eQuartile 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e616\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eQuartile 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e0.99 (0.83-1.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e0.96 (0.81-1.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e0.96 (0.81-1.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eQuartile 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e1.06 (0.87-1.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e1.04 (0.85-1.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e1.04 (0.85-1.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eQuartile 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e0.79 (0.58-1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e0.75 (0.55-1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e0.75 (0.55-1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eP\u0026nbsp;for trend\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e0.462\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e0.256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e0.282\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eCovariates adjusted in the Cox regression analysis Model\u0026nbsp;1\u003c/strong\u003e: Age at enrollment, enrollment source and Race.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eModel\u0026nbsp;2\u003c/strong\u003e: Model 1 covariates plus marital status, BMI, age at menarche, parity, menopause status, mammogram ever, history of breast cyst, history of breast cancer in mother and/or sister, Health Eating Index, physical activity level and comorbidity status.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eModel\u0026nbsp;3\u003c/strong\u003e: Model 2 covariates, plus household income and education status. Statistical significance at 95% confidence interval, p value = 0.05.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 789px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 4 Association of Neighbourhood Deprivation Index (NDI) with breast cancer specific mortality (death) for\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eall\u0026nbsp;races\u0026nbsp;and\u0026nbsp;by\u0026nbsp;race stratification\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExposure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeaths\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(N=218)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMode 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eaHR\u0026nbsp;(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eaHR\u0026nbsp;(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eaHR\u0026nbsp;(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eALL\u0026nbsp;Races\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eQuartile 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eQuartile 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.79 (0.56-1.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e1.12 (0.70-1.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e1.23 (0.76-1.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eQuartile 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1.04 (0.72-1.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e1.01 (0.61-1.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e0.93 (0.55-1.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eQuartile 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.78 (0.47-1.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e0.92 (0.45-1.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e1.13 (0.49-2.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eP\u0026nbsp;for trend\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.493\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e0.326\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e0.503\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhite American\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eQuartile 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eQuartile 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.82 (0.36-1.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e0.70 (0.24-2.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e0.71 (0.23-2.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eQuartile 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1.38 (0.62-3.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e1.58 (0.59-4.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e1.39 (0.50-3.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eQuartile 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1.11 (0.48-2.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e1.43 (0.52-3.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e1.92 (0.62-5.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eP\u0026nbsp;for trend\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.416\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAfrican\u0026nbsp;American\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eQuartile 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eQuartile 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.90 (0.59-1.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e1.03 (0.65-1.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e1.12 (0.71-1.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eQuartile 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1.02 (0.63-1.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e0.78 (0.44-1.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e0.76 (0.42-1.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eQuartile 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eP\u0026nbsp;for trend\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e0.155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e0.222\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 789px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCovariates\u0026nbsp;adjusted\u0026nbsp;in\u0026nbsp;the\u0026nbsp;Cox\u0026nbsp;regression\u0026nbsp;analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 789px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel\u0026nbsp;1\u003c/strong\u003e: Adjusted for age at diagnosis and enrollment source.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 789px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel\u0026nbsp;2\u003c/strong\u003e: Adjusted with Model 1 covariates, plus BMI, total physical activity time (MET), comorbidity status and\u003c/p\u003e\n \u003cp\u003etreatment:\u0026nbsp;chemotherapy,\u0026nbsp;surgery\u0026nbsp;and\u0026nbsp;radiotherapy.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 789px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel\u0026nbsp;3\u003c/strong\u003e: Adjusted with Model 2 covariates, plus household income and education status.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 789px;\"\u003e\n \u003cp\u003eStatistical\u0026nbsp;significance\u0026nbsp;at\u0026nbsp;95%\u0026nbsp;confidence\u0026nbsp;interval,\u0026nbsp;p\u0026nbsp;value\u0026nbsp;=\u0026nbsp;0.05.\u003c/p\u003e\n \u003cp\u003e* Number of deaths less than 4, hazards ratios not reported due to participants being less than 10 under the quartile category.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Breast cancer, Risk, Survival, Community-level deprivation, Neighbourhood Deprivation Index (NDI)","lastPublishedDoi":"10.21203/rs.3.rs-7594853/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7594853/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudies on the association of community-level deprivation indices with breast cancer risk and survival after breast cancer diagnosis have yielded mixed results, and few have included large enough samples of low-income and ethnic minority individuals and considered individual-level risk factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study included 43,384 cancer-free female participants enrolled from 2002-2009 in the Southern Community Cohort Study (SCCS), a prospective cohort study of predominantly low- income individuals and followed through December 2019 to ascertain incident breast cancer and survival outcomes. In-person or mailed baseline surveys collected information on demographic, reproductive and lifestyle factors. Neighbourhood deprivation index (NDI) was estimated based on participants’ residential zip codes and the 2000 census tract data. We conducted multivariable Cox regression analyses to evaluate the association of NDI with the risk of developing breast cancer and breast cancer-specific survival while adjusting for confounding effects of reproductive, lifestyle, clinical, and individual-level socioeconomic factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproximately 69% of participants were Black, 31% were white, and 78% had family income \u0026lt;\u003c/p\u003e\n\u003cp\u003e$25,000/year. After a median follow-up of 12.8 years, 1,363 women were diagnosed with incident breast cancer (median age at diagnosis of 54.0 (IQR 13.0) years); 365 of them died, and 218 died from breast cancer. White women living in the least deprived communities had a significantly increased risk of developing breast cancer but not dying from breast cancer, with a hazard ratio (HR) of 1.44 (95% confidence interval (CI) 1.05-1.96) and 1.11 (95% CI; 0.48- 2.59), respectively. Among Black women, NDI was not associated with breast cancer risk or survival.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis large cohort of Black and white women with predominantly low-income background found no evidence that living in a deprived neighbourhood further increases the incidence and mortality of breast cancer.\u003c/p\u003e","manuscriptTitle":"Association of community-level deprivation with breast cancer risk and survival among women residing in the southeastern United States","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-10 13:26:37","doi":"10.21203/rs.3.rs-7594853/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"104493313390065302193089153144721254989","date":"2025-11-07T14:00:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-29T11:38:41+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-06T08:02:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-01T11:32:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-01T07:46:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-09-30T06:10:13+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9dc70a15-070a-4d38-837f-91423426002f","owner":[],"postedDate":"November 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-10T13:26:37+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-10 13:26:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7594853","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7594853","identity":"rs-7594853","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}