Metropolitan Statistical Area Level Research Articles

Estimating HIV Incident Diagnoses Among Men Who Have Sex With Men Eligible for Pre-exposure Prophylaxis but Not Taking It: Protocol and Feasibility Assessment of Data Sources and Methods

HIV incidence estimates are published each year for all Ending the HIV Epidemic (EHE) counties, but they are not stratified by the demographic variables highly associated with risk of infection. Regularly updated estimates of HIV incident diagnoses available at local levels are required to monitor the epidemic in the United States over time and could contribute to background incidence rate estimates for alternative clinical trial designs for new HIV prevention products. We describe methods using existing, robust data sources within areas in the United States to reliably estimate longitudinal HIV incident diagnoses stratified by race and age categories among men who have sex with other men (MSM) eligible for pre-exposure prophylaxis (PrEP) but not taking it. This is a secondary analysis of existing data sources to develop new estimates of incident HIV diagnoses in MSM. We reviewed past methods used to estimate incident diagnoses and explored opportunities to improve these estimates. We will use existing surveillance data sources and population sizes of HIV PrEP-eligible MSM estimated from population-based data sources (eg, US Census data and pharmaceutical prescription databases) to develop metropolitan statistical area-level estimates of new HIV diagnoses among PrEP-eligible MSM. Required parameters are number of new diagnoses among MSM, estimates of MSM with an indication for PrEP, and prevalent PrEP use including median duration of use; these parameters will be stratified by jurisdiction and age group or race or ethnicity. Preliminary outputs will be available in 2023, and updated estimates will be produced annually thereafter. Data to parameterize new HIV diagnoses among PrEP-eligible MSM are available with varying levels of public availability and timeliness. In early 2023, the most recent available data on new HIV diagnoses were from the 2020 HIV surveillance report, which reports 30,689 new HIV infections in 2020, and 24,724 of them occurred in an MSA with a population of ≥500,000. Updated estimates for PrEP coverage based on commercial pharmacy claims data through February 2023 will be generated. The rate of new HIV diagnoses among MSM can be estimated from new diagnoses within each demographic group (numerator) and the total person-time at risk of diagnosis for each group (denominator) by metropolitan statistical area and year. To estimate time at risk, the person-time of individuals on PrEP or person-time after incident HIV infection but before diagnosis should be removed from stratified population size estimates of the total number of person-years with indications for PrEP. Reliable, serial, cross-sectional estimates for rates of new HIV diagnoses for MSM with PrEP indications can serve as benchmark community estimates of failures of HIV prevention and opportunities to improve services and will support public health epidemic monitoring and alternative clinical trial designs. DERR1-10.2196/42267.

2059. Estimated Background HIV Diagnosis Rates among People Who Could Benefit from Pre-Exposure Prophylaxis (PrEP) at the Metropolitan Statistical Area (MSA) level in the United States, 2012-2019

Abstract Background Identifying areas of high background HIV diagnosis rates (bHIV) is critical for future PrEP trials using counterfactual study designs to estimate efficacy and to facilitate effective implementation of HIV prevention interventions. In this study, we used a multiple data source model to estimate bHIV between 2012 and 2019 in people who could benefit from PrEP (PWBP) but are not taking PrEP to identify with greater precision areas of high HIV transmission at the Metropolitan Statistical Area (MSA) level. We compared bHIV in PWBP in PURPOSE2 (NCT04925752) trial sites to those in the DISCOVER trial (NCT02842086) to demonstrate how this approach can inform site selection in future PrEP clinical trials and support delivery of PrEP interventions. Methods Number of new HIV diagnoses, number of individuals with a PrEP indication, and person-time on PrEP or after HIV diagnosis (obtained from published surveillance data) and pharmacy claims data (IQVIA PharMetrics Plus) were used to calculate estimated bHIV in a multivariate Poisson regression model for PWBP in 108 MSAs and across states between 2012 and 2019. Results Overall, bHIV among PWBP decreased from 4.42 per 100 person-years (PY) (95% CI 4.38 – 4.47) in 2012 to 3.14 per 100 PY (95% CI 3.10 – 3.17) in 2019. However, bHIV among PWBP in MSAs with PURPOSE2 trial sites were consistently higher (from 4.69 per 100 PY [95% CI 4.56 – 4.81] in 2012 to 3.58 per 100 PY [95% CI 3.49 – 3.67] in 2019) compared to areas with DISCOVER-only sites (from 3.77 per 100 PY [95% CI 3.53 – 4.01] in 2012 to 2.83 per 100 PY [95% CI 2.63 – 3.03] in 2019; Figure 1A). Within states, we identified specific localities with high bHIV among PWBP, such as in Illinois where state level HIV diagnosis rate was 2.65 per 100 PY [95% CI 2.50 – 2.80] but as high as 6.04 per 100 PY [95% CI 5.67 - 6.40] in the MSA with a PURPOSE2 site (Figure 1B). Figure:Estimated background HIV diagnosis rates (bHIV) in people who could benefit from PrEP by MSAs selected by DISCOVER/PURPOSE2 trials (A) from 2012 to 2019 and (B) in 2019 in the US. Conclusion We found considerable variation in bHIV at the MSA level among PWBP who are not taking PrEP, including a concentration of MSAs in the Southeastern US with high rates of new HIV diagnosis. Our methodology for leveraging existing surveillance data to identify areas of high bHIV with greater precision may provide a valuable approach to support future counterfactual clinical trial designs and prioritize resources for delivery of PrEP services. Disclosures Melanie de Boer, PhD, Gilead Sciences: Employee|Gilead Sciences: Stocks/Bonds Jason Yuan, n/a, Gilead Sciences: Employee|Gilead Sciences: Stocks/Bonds Juan Yang, PhD, Gilead Sciences: Employee|Gilead Sciences: Stocks/Bonds Lillian Brown, MD, PhD, Gilead Sciences: Stocks/Bonds Carlo Hojilla, PhD, Gilead Sciences: Employee|Gilead Sciences: Stocks/Bonds Christoph C. Carter, MD, PhD, Gilead Sciences: Employee|Gilead Sciences: Employee|Gilead Sciences: Stocks/Bonds|Gilead Sciences: Stocks/Bonds Moupali Das, MD, Gilead Sciences: Employee|Gilead Sciences: Employee|Gilead Sciences: Stocks/Bonds|Gilead Sciences: Stocks/Bonds Li Tao, MD, PhD, Gilead Sciences: Employee|Gilead Sciences: Employee|Gilead Sciences: Stocks/Bonds|Gilead Sciences: Stocks/Bonds.

Bayesian inference in spatial GARCH models: an application to US house price returns

ABSTRACT In this paper we consider a high-order spatial generalized autoregressive conditional heteroskedasticity (GARCH) model to account for the volatility clustering patterns observed over space. The model consists of a log-volatility equation that includes the high-order spatial lags of the log-volatility term and the squared outcome variable. We use a transformation approach to turn the model into a mixture of normals model, and then introduce a Bayesian Markov chain Monte Carlo (MCMC) estimation approach coupled with a data-augmentation technique. Our simulation results show that the Bayesian estimator has good finite sample properties. We apply a first-order version of the spatial GARCH model to US house price returns at the metropolitan statistical area level over the period 2006Q1–2013Q4 and show that there is significant variation in the log-volatility estimates over space in each period.

Trade-offs in the relationship between competition and audit quality

PurposeFears over public accounting becoming increasingly concentrated have inspired several attempts to study the relationship between competition and audit quality. These studies have yielded conflicting results without a clear reason as to why. This paper aims to propose a new approach and empirically demonstrate a non-monotonic association between competition and audit quality.Design/methodology/approachUsing metropolitan statistical area level data from the USA over the period of 2000–2014, the author shows that the effect that changes in the competition will have on audit quality depends upon the current competitive state of the market.FindingsAudit quality is at its highest level when competition is neither too high nor too low. In addition, the point of inflection at which competition turns from being helpful to harmful is influenced by the saturation of the Big 4 auditors in the market.Practical implicationsThese findings can help explain the mixed results of the literature and provide insight into the role that regulators can play in modulating competition.Originality/valueThis is the first paper to document a non-monotonic relationship between competition and audit quality. By introducing and exploring the validity of a non-monotonic component in the audit quality equation, the authors can better determine, which competitive structures generate desired levels of audit quality.

Use of Outpatient Intravenous Calcitropes for Heart Failure in the United States

BackgroundOutpatient calcitrope infusions—that is, the cardiac inotropes milrinone and dobutamine—are often used for bridge to transplantation and palliation in advanced heart failure, but few data exist about the real-world use of these agents. Methods and ResultsWe used the Symphony Integrated DataVerse of commercial, managed Medicare, and Medicaid insurance claims of approximately 280 million people (2012–2020) to determine the incidence and characteristics of ambulatory calcitrope use. Demographics were calculated, including geographic densities at the metropolitan statistical area level. A population projection normalized for age, sex, and location was extrapolated to the total US population. Ambulatory dispensing of milrinone was found in 10,533 outpatients, 1867 in 2019. Ambulatory dobutamine use was found in 4967 outpatients, 836 in 2019. The 2019 total US projection was 3411 for milrinone and 1281 for dobutamine. The mean age was 62 years for milrinone and 68 for dobutamine. Males represented 70% of use. There were differences between drugs in geographic distribution, with more milrinone use in the Northeast and South and more dobutamine use in the Midwest. Duration of use was 4.6 ± 7.2 months for milrinone and 1.8 ± 4.0 months for dobutamine. Of the patients receiving milrinone, 30.6% subsequently underwent cardiac transplantation or left ventricular assist device placement, whereas 10% receiving dobutamine went on to advanced therapies. Less than 0.5% of patients received calcitropes while enrolled in hospice care. ConclusionsMore than 4000 patients receive outpatient infusion of calcitropes annually in the outpatient setting. Men are much more likely to receive these medications. A minority of the use is as a bridge to advanced therapies. Geographic variability in use suggests better evidence and consistent guidelines may be helpful.

Metropolitan statistical area location choice by foreign direct investors in the United States

AbstractThe importance of new foreign direct investment as a vehicle for the formation of productive capital has stimulated interest in understanding why multinational enterprises (MNEs) choose particular locations for their investments. Using data from greenfield investments reported on the Bureau of Economic Analysis Survey of new foreign direct investment in the United States, I analyze how locational characteristics influence the choice of where foreign MNEs establish their new investments in the United States. Identifying location choice at the metropolitan statistical area level allows me to analyze both traditional determinants of location choice such industrial agglomeration as well as measures of international connectivity that have been studied in research on global cities. My results support the finding that global cities are attractive to foreign direct investors in the United States not just by virtue of their population or industrial agglomeration, which serve to attract investment, but by virtue of a much wider set of attributes, related to their demography and connections to the wider world.

Impacts of transportation network companies on urban mobility

The role of transportation network companies (TNCs) in the urban transport system is under intense debate. In this study, we systematically assess three aspects of the net impacts of TNCs on urban mobility in the United States—road congestion, transit ridership and private vehicle ownership—and examine how these impacts have evolved over time. Based on a set of fixed-effect panel models estimated using metropolitan statistical area level data, we find that the entrance of TNCs led to increased road congestion in terms of both intensity (by 0.9%) and duration (by 4.5%), an 8.9% decline in transit ridership and an insignificant change in vehicle ownership. Despite the ideal of providing a sustainable mobility solution by promoting large-scale car sharing, our analysis suggests that TNCs have intensified urban transport challenges since their debut in the United States. The use and growth of ride-sharing apps in recent years has changed urban transportation patterns. This article examines their impacts on congestion, mass transit ridership and private car ownership in North American cities.

Out of the Class and Into the Shadows: Immigration Enforcement and Education Among U.S.-Citizen and Foreign-Born Hispanics

With the recent escalation in interior immigration enforcement across the United States, immigrant and U.S.-born children are increasingly exposed to coercive measures that have been shown to disrupt their development. This study examines the relationship between immigration-related arrests and the educational outcomes of Hispanics—a group that is overwhelmingly targeted by immigration authorities. Using data on the number of U.S. Immigration and Customs Enforcement arrests at the Metropolitan Statistical Area level, we estimate the impact of immigration enforcement on Hispanics’ school enrollment. We find that increases in the arrest rate are accompanied by substantial declines in enrollment among Hispanic youth, including U.S.-born, foreign-born, and individuals in mixed-status families. Additionally, we do not find evidence of this relationship among other racial/ethnic groups, suggesting that the impact is concentrated among Hispanic individuals. Our results advance our understanding of the unintended consequences of immigration enforcement on educational outcomes and show that ethnicity is a crucial factor in this process.

Hot and cold seasons in Texas housing markets

Purpose This paper aims to use statistical analyses to understand the trends on housing liquidity and pricing by accounting for macroeconomic factors that vary at national level and at metropolitan statistical area level for all metropolitan statistical areas in Texas. In addition, the authors test for seasonality in all the metropolitan statistical areas in Texas. Design/methodology/approach Using publicly available data from Zillow a listing website, the authors conduct an analysis of all housing markets at metropolitan statistical area level in Texas to understand the factors that drive the liquidity and pricing. The authors use two measures for liquidity, namely, time to sell the house and sales to list ratio. The authors also try to understand the decision to lower the price of the listed houses. In addition, the authors conduct a test for seasonality within the year in these housing markets. Findings The analyses conclude that there is a significant impact of listing prices, unemployment rates, 30-year mortgage rates, consumer sentiment and oil price changes on the liquidity of the housing markets and decisions of sellers to adjust the prices down. In addition, the authors provide evidence of the existence of seasonality in most metropolitan statistical areas in Texas both for pricing and volume of transactions. Originality/value This is the first study to look at housing liquidity and pricing trends for about 25 markets in Texas. In addition, the authors provide evidence of the importance of oil prices for the housing markets in Texas metropolitan statistical areas.

Estimation of new HIV diagnosis rates among high-risk, PrEP-eligible individuals using HIV surveillance data at the Metropolitan Statistical Area level in the United States.

IntroductionNew HIV diagnoses have fallen in the past decade due to increased HIV testing, earlier diagnosis, earlier antiretroviral treatment, improved linkage to care and engagement in care, and the recent increased uptake of pre‐exposure prophylaxis (PrEP). We propose a novel method to compute the rate of new HIV diagnoses at the Metropolitan Statistical Area (MSA) level in the US to support the evaluation of comprehensive treatment and prevention efforts over time.MethodsThe number of new HIV diagnoses, number of individuals with a PrEP indication and aggregated person‐time exposed to PrEP during the years 2012 to 2017 were used to compute a new HIV diagnosis rate for people at risk of HIV excluding those already on PrEP for the 105 MSAs in the US with published HIV surveillance data. In our calculation of person‐time with a PrEP indication, time‐at‐risk excluded time on PrEP and time after an HIV diagnosis. We used a multivariate Poisson regression model to estimate HIV diagnosis rates by year and location.ResultsFrom 2012 to 2017, the aggregate HIV diagnoses rate among high‐risk individuals with an indication for PrEP in the 105 MSAs decreased from 4.14 per 100 person‐years (PY) (95% CI 4.10 to 4.19) to 3.26 per 100 PY (95% CI 3.22 to 3.30). For the 25 US MSAs that overlapped with an ongoing large randomized clinical trial of PrEP in men who have sex with men (MSM), the HIV diagnosis rate from 2012 to 2017 decreased from 4.86 per 100 PY (95% CI 4.80 to 4.93) to 3.61 per 100 PY (95% CI 3.56 to 3.66), a decline that was more rapid than in non‐study MSAs (IRR for trial site 1.19, 95% CI 1.18 to 1.20).ConclusionsWe propose a model to estimate the background HIV diagnosis rate in people at risk for HIV and with a PrEP indication in US MSAs (excluding those on PrEP) using publically available surveillance data which can evaluate trends over time. Data generated using this methodology could be used by policy makers and local HIV prevention specialists to evaluate and monitor their prevention efforts for the population at risk in their communities.

The Characteristics of Out-Patient Use of Intravenous Milrinone in the United States

Introduction Out-patient inotrope use has limited indications, but the extent of its actual use is not known. We used the SYMPHONY database of about 240 million people (2012-2018) to determine incidence of out-patient milrinone use & the nature of patients (pts) prescribed the medications. Methods Milrinone use was defined as at least 1 use of milrinone in an outpatient setting. To ensure that the drug was not given for testing purposes, no imaging event could be recorded on the same date as the milrinone use. Demographics were calculated, including geographic densities at the Metropolitan Statistical Area level. To estimate the total number of patients receiving these drugs in the US in 2016 & 2017, a population projection was performed to extrapolate from the database population to the total US Population. The projection was normalized based on age, gender & location. Results In 2016, there were 678 pts receiving milrinone as an out-patient in SYMPHONY, leading to a national projection of 1164 ± 96. In 2017, there were 580 pts, with a national projection of 975 ± 88. The SYMPHONY database is similar to census data with slightly less Medicaid and Medicare representation. The milrinone pts were older, more likely to be male, less likely to reside in the West and more likely to have Medicare. The mean age was 54 ± 21 years, with a median of 59 years. Concomitant medication use showed a relatively low prescription of cardiac medications. Loop diuretics were used in 58% of pts, beta adrenergic blockers in 51%, and ACE or ARB in 40%. ICD's were present in 45%, and LVAD's were placed in 8% of pts. More than 20% of pts had some indication of an acute event, with 10% having a morphine or fentanyl prescription, 5% with a prescribed hospital bed at home. Conclusion There is geographic variability in the use of home milrinone, and the patients receiving it are relatively young. While some use of home milrinone appears to be as a bridge to advanced heart failure treatment, much appears to be related to end of life care.

Local economic freedom and creative destruction in America

Economic freedom facilitates the market selection mechanism that enables the Schumpeterian creative destruction process. I develop a framework depicting how economic freedom, which reduces entry barriers and transaction costs, acts as an external enabler that facilitates the creation of firms and jobs. It also facilitates the market correction device, potentially serving as a disabling force to allow firm and job destruction. Using a novel metropolitan statistical area–level dataset, I investigate empirically the role of local economic freedom on dynamism for a sample of nearly 300 U.S. cities over the period 1972–2012. My results confirm that economic freedom is positively associated with firm and job creation, but it has no effect on firm and job destruction.

Factors Affecting Travel Demand by Bus: An Empirical Analysis at U.S. Metropolitan Statistical Area Level

Understanding the nature of transit travel demand is at the heart of transportation policy making and the success of transit systems. Unfortunately, most existing studies focus narrowly on a single...

Do Cities and Counties Attempt to Circumvent Changes in Their Autonomy by Creating Special Districts?

This study uses 40 years of data from the U.S. Census of Governments to examine the impact of changes in local autonomy on the creation of the fastest growing form of local governments, special districts. Using fixed effects regression specified at the urban county and metropolitan statistical area level, we find that restrictions of fiscal autonomy of cities are associated with creation of new special districts. When the limits on fiscal autonomy interact with grants of functional autonomy, amplification occurs. We find no analogous effects for county governments. These two findings are consistent with the circumvention argument made in the local autonomy literature.

Theory to Practice: Policy Recommendations for Fostering Economic Development through Social Capital

Abstract Proponents of social capital theory have long argued not only that it is in the best interest of civic life to build social capital but also that social capital is vital for the economic health of communities. This has been confirmed by recent research showing that social capital, especially in its bridging form, is positively associated with job creation at the metropolitan statistical area level. At the same time, social capital is often viewed as something either inherent or absent within a community. This article takes on that assumption by presenting a policy‐based approach to developing social capital. It provides two theoretical explanations for how social capital affects economic development and identifies four lessons for economic development practitioners to use to enhance social capital. These research‐based recommendations for economic development practitioners and policy makers seek to improve the social capital and, consequently, the economic development of their community.

Anesthesia Service Use and the Uptake of Screening Colonoscopies.

The Center for Medicare & Medicaid Services recently defined "screening colonoscopy" to include separately furnished anesthesia services. To examine the relationship between anesthesia service use and the uptake of screening colonoscopies. We correlated metropolitan statistical area (MSA) level anesthesia service use rates, derived from the 2008, 2010, and 2012 Medicare and MarketScan claims data, with the presence of individual level guideline concordant screening colonoscopy using the Behavioral Risk Factor Surveillance System data for the same years. Proportion of colonoscopies with anesthesia service was calculated at the MSA level. A guideline concordant screening colonoscopy was defined as a colonoscopy received within the past 10 years. The average MSA level anesthesia service use rate in colonoscopy significantly increased from 25.34% in 2008 to 44.25% in 2012; but only a moderate increase in the rate of guideline concordant colonoscopies was observed, from 57.36% in 2008 to 65.32% in 2012. After adjusting for patient characteristics, we found a nonsignificant negative association between anesthesia service use rate and colonoscopy screening rate, with an odds ratio of 0.90 for receiving a guideline concordant colonoscopy for each percentage point increase in anesthesia service use rate (P=0.27). The relationship between anesthesia service use and the overall colorectal cancer screening rate followed the same pattern and was also not statistically significant. No significant association between anesthesia service use and colonoscopy screening or colorectal cancer screening rates was found, suggesting that more evidence is needed to support the Center for Medicare & Medicaid Services rule change.

Do Cities and Counties Attempt to Circumvent Changes in Their Autonomy by Creating Special Districts?

This study uses forty years of data from the US Census of Governments to examine the impact of changes in local autonomy on the creation of the fastest growing form of local governments, special districts. Using fixed effects regression specified at the urban county and metropolitan statistical area level, we find that restrictions of fiscal autonomy of cities is associated with creation of new special districts. When the limits on fiscal autonomy interacts with grants of functional autonomy, amplification occurs. We find no analogous effects for county governments. These two findings are consistent with the circumvention argument made in the local autonomy literature.

Does Segregation Lead to Lower Birth Weight?: An Instrumental Variable Approach.

Racial residential segregation in the United States has been linked to racial differences in birth outcomes, with studies reporting associations between segregation and birth weight. However, this relationship is likely confounded, and many individual and neighborhood-level covariates included in previous models are likely mediators, potentially obscuring any causal impact of segregation on birth weight. We compiled a record of non-Hispanic black and white singleton births to US-born/resident mothers in 2000, linked to segregation indices at the metropolitan statistical area (MSA) level in the non-Southern US. Segregation was measured via the dissimilarity index. The outcomes were individual-level birth weight and the metropolitan statistical area-level black/white gap in birth weight. We instrumented for segregation using the railroad division index. We compared race-stratified ordinary least squares models to two-stage least squares models, with cluster robust standard errors. We estimated a 1.2 g decrease in black birth weight for every one-percentage point increase in segregation (95% confidence interval [CI]: -1.9, -0.50) via ordinary least squares but a 2.8 g decrease (95% CI: -6.0, 0.48) using two-stage least squares. For white infants, our ordinary least squares estimate was 0.53 (95% CI: -0.23, 1.3), and our two-stage least squares estimate was in the opposite direction (-0.68, 95% CI: -3.5, 2.1). Ordinary least squares estimates may understate the effect of segregation on birth weight in blacks. Evidence from instrumental variable models was consistent with a causal impact of segregation on black birth outcomes, but estimates were imprecise and may be affected by weak instrument bias.

Measuring Prices in Health Care Markets Using Commercial Claims Data.

To compare methods of price measurement in health care markets. Truven Health Analytics MarketScan commercial claims. We constructed medical prices indices using three approaches: (1) a "sentinel" service approach based on a single common service in a specific clinical domain, (2) a market basket approach, and (3) a spending decomposition approach. We constructed indices at the Metropolitan Statistical Area level and estimated correlations between and within them. Price indices using a spending decomposition approach were strongly and positively correlated with indices constructed from broad market baskets of common services (r > 0.95). Prices of single common services exhibited weak to moderate correlations with each other and other measures. Market-level price measures that reflect broad sets of services are likely to rank markets similarly. Price indices relying on individual sentinel services may be more appropriate for examining specialty- or service-specific drivers of prices.

Abstract B27: Neighborhood racial concentration and hormone receptor status among California women diagnosed with breast cancer

Abstract Introduction: Recent evidence indicates that black women living in highly segregated metropolitan areas when diagnosed with breast cancer may receive their diagnosis at an earlier stage and have reduced cancer-specific and all-mortality rates if their neighborhood has a higher proportion of black residents. We conducted a cross-sectional, multilevel analysis of California Cancer Registry records merged with data from the California Neighborhoods Data System to determine whether the odds of having estrogen and progesterone negative (ER-/PR-) breast cancer are also reduced under similar neighborhood sociodemographic conditions. Methods: A total of 88,205 non-Hispanic white, non-Hispanic black, and Hispanic women, ages 18 to 108 at diagnosis with invasive breast cancer between 1996 and 2004 and lived in a census block group within a California metropolitan statistical area (MSA) were included in the analysis. Block groups were used as the neighborhood-level unit of analysis. Racial residential segregation was assessed at the MSA level and was operationalized using the multigroup entropy index, a measure of “evenness,” or the degree to which all racial groups present in an MSA are evenly distributed across its component parts (i.e., census tracts). Results: Controlling for block group socioeconomic status and individual sociodemographic and tumor characteristics, higher percent of black residents in a neighborhood significantly reduced the odds of having ER-/PR- breast cancer relative to having ER+/PR+ cancer among black women (-3.7% for every 10% increase in black neighborhood residents; p = 0.01). When the analysis was further stratified by multigroup entropy scores, black women residing in highly segregated MSA's had a similar reduction in ER-/PR- risk (-3.8% for every 10% increase in black neighborhood residents; p = 0.02), but the reduction was only marginally significant in less segregated MSA's (-4.1% for every 10% increase in black neighborhood residents; p = 0.10). There was a modest increase in the risk of ER-/PR- subtype among Hispanics not accounting for segregation(+4.6% for every 10% increase in black neighborhood residents; p = 0.053), and among Hispanics living in less segregated MSA's (+7.0% for every 10% increase in black neighborhood residents; p = 0.074), but not among Hispanics living in more segregated metropolitan areas. No associations between neighborhood black composition and ER-/PR- subtype were observed among whites. The neighborhood concentration of Hispanic residents generated a different pattern of ER-/PR- risk. Among Hispanic women, greater percentages of Hispanic neighborhood residents increased the odds of having ER-/PR- versus ER+/PR+ breast cancer (+2.7% for every 10% increase in Hispanic neighborhood residents, p < 0.01). Similar increases in risk were seen among non-Hispanic white women (+1.9% for every 10% increase in Hispanic neighborhood residents, p = 0.01), but there was no association among blacks. Stratifying on MSA-level racial segregation, we found similarly significant increases in ER-/PR- risk among whites and Hispanics within both more and less segregated metropolitan areas. No statistically significant relationship was noted among black women residing in low segregation MSA's, but there was a marginally significant decrease in ER-/PR- risk among black residents of more highly segregated MSA's (-4.1% for every 10% increase in Hispanic block group residents; p = 0.05). Conclusions: The racial/ethnic composition of neighborhoods is associated with the risk of ER-/PR- subtype among Californian women diagnosed with breast cancer. This relationship differs across racial/ethnic groups, and to a lesser extent, by the degree of race-based residential segregation across the broader metropolitan area. Citation Format: Erin Linnenbringer, Scarlett Lin Gomez. Neighborhood racial concentration and hormone receptor status among California women diagnosed with breast cancer. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B27. doi:10.1158/1538-7755.DISP13-B27