Association between neighborhood opportunity, allostatic load, and all-cause mortality in patients with breast cancer

Adverse neighborhood contextual factors may affect breast cancer outcomes through environmental, psychosocial, and biological pathways. A study at The Ohio State University (Columbus) examined the relationship between allostatic load (AL), neighborhood opportunity (composite measure derived for neighborhood level transportation, education, employment, health, housing, crime, and environment), and all-cause mortality among patients with breast cancer. Among 4,089 patients, residence in neighborhoods with a low opportunity index was associated with high AL (OR 1.21; 95% CI 1.05-1.40) and greater risk of all-cause mortality (aHR 1.45; 95% CI 1.11-1.89). Relative to the highest (99^th percentile) level of opportunity, risk of all-cause mortality steeply increased up to the 70^th percentile, at which point te rate of increase plateaued. The authors conclude that lower neighborhood opportunity was associated with higher AL and greater risk of all-cause mortality among patients with breast cancer.