Structural Racism and Triple-Negative Breast Cancer Among Black and White Women in the United States.

To determine the associations between state-level indicators of structural racism and incidence of triple-negative breast cancer (TNBC) among black and white women diagnosed with breast cancer. Black and white women diagnosed with breast cancer between 2010 and 2016 were identified from 12 states represented in the Surveillance, Epidemiology, and End Results (SEER18) program. State-level disparities were measured by black to white rate ratios in educational attainment, political participation, incarceration, and unemployment; and dichotomized to "high" or "low" structural racism using the median rate ratio of the 12 states. Logistic regression was used to examine the associations between indicators of structural racism and TNBC among black and white women. Living in states with high levels of structural racism in the domains of educational attainment, judicial treatment, and political participation were generally associated with greater odds of TNBC among black and white women. The increased odds of TNBC was greater for black women living in states with high levels of racial disparities than white women. Among black women diagnosed with breast cancer, the odds ratio (OR) of being diagnosed with TNBC comparing women living in states with high disparities in educational attainment versus those with low disparities was 1.50 (95% confidence interval [CI]: 1.27-1.77). For white women, the OR for educational attainment was 1.17 (95% CI: 1.10-1.23). Results from this study support the notion that racial health disparities need to be contextualized. Further research should address mechanisms through which structural racism influences health disparities.