Date of Conferral

9-22-2026

Date of Award

September 2026

Degree

Doctor of Public Health (DrPH)

School

Health Sciences

Advisor

Richard Jiménez

Abstract

Breast cancer-specific mortality in the United States remains higher among women in rural and socioeconomically disadvantaged areas, yet few population-based studies have been conducted to jointly scrutinize demographic and structural determinants of this disparity. Informed by the social determinants of health framework, this secondary data analysis, using records from the SEER Research Plus database, examined the association between age at diagnosis, race and ethnicity, rural/urban residence, county-level median household income, and breast cancer-specific mortality among U.S. women aged 18 and older diagnosed with malignant invasive breast cancer between 2010 and 2020 (N = 285,865). Bivariate chi-square tests and binary logistic regression were used to assess associations between the predictors and breast cancer-specific mortality. Rural residence was associated with significantly higher odds of breast cancer-specific death than urban residence (AOR = 1.177, 95% CI [1.133, 1.224]), and higher county-level median household income was associated with significantly lower odds of mortality (AOR = 0.929, 95% CI [0.924, 0.935]). These findings indicate that demographic and structural conditions, particularly geographic and economic disadvantage, contribute independently and jointly to breast cancer survival disparities among U.S. women. Results may help inform public health strategies and resource allocation aimed at reducing these disparities, supporting positive social change through more equitable, place-based approaches to cancer prevention and care.

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