Abstract
BackgroundFactors beyond the individual level such as those characterizing the residential environment may be important to breast cancer outcomes. We provide a systematic review and results of meta-analysis of the published empirical literature on the associations between breast cancer risk and mortality and features of the residential environment.MethodsUsing PRISMA guidelines, we searched four electronic databases and manually searched the references of selected articles for studies that were published before June 2013. We selected English language articles that presented data on adult breast cancer incidence or mortality in relation to at least one area-based residential (ABR) independent variable.ResultsWe reviewed 31 eligible studies, and observed variations in ABR construct definition and measurement, study design, and analytic approach. The most common ABR measures were indicators of socioeconomic status (SES) (e.g., income, education, summary measures of several SES indicators or composite SES). We observed positive associations between breast cancer incidence and urbanization (Pooled RR for urban vs. rural: 1.09. 95% CI: 1.01, 1.19), ABR income (Pooled RR for highest vs. lowest ABR income: 1.17, 95% CI: 1.15, 1.19) and ABR composite SES (Pooled RR for highest vs. lowest ABR composite SES: 1.25, 95% CI: 1.08, 1.44). We did not observe consistent associations between any ABR measures and breast cancer mortality.ConclusionsThe findings suggest modest positive associations between urbanization and residential area socioeconomic environment and breast cancer incidence. Further studies should address conceptual and methodological gaps in the current publications to enable inference regarding the influence of the residential environment on breast cancer.
Highlights
Factors beyond the individual level such as those characterizing the residential environment may be important to breast cancer outcomes
Overall, residing in urban areas and in higher socioeconomic areas characterized by higher income, and composite socioeconomic status (SES) was associated with higher breast cancer incidence
This review imposed no restriction on geographic location of published studies. This is important to highlight differences and similarities in studies across countries, which may provide important information about potential effect modifiers. In conclusion, this is the first systematic review and metaanalysis of studies examining the associations between area-based residential (ABR) constructs and breast cancer incidence and mortality
Summary
Factors beyond the individual level such as those characterizing the residential environment may be important to breast cancer outcomes. We provide a systematic review and results of meta-analysis of the published empirical literature on the associations between breast cancer risk and mortality and features of the residential environment. The residential environment may play a role in breast cancer incidence and mortality through the geographic distribution of breast cancer risk factors, access to quality and timely healthcare resources and medical treatment, as well as through psychosocial pathways involving stress and social support [3,4,5]. Understanding the association between features of the residential environment and breast cancer outcomes may provide insight into factors relevant to risk reduction, adequate screening and timely treatment, and guide primary, secondary and tertiary prevention efforts
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