Black Culture, Public Health, Health Equity
Association of Cultural Racism with Breast Cancer Survival Among United States Adults, 2018–2020
Anjali Gupta, Oyomoare L. Osazuwa-Peters, Andrea Thoumi, Hugo G. Quezada-Pinedo, Nancy Krieger, Tyson Brown, Tomi Akinyemiju
June 8, 2026 at 1:15:16 PM
Abstract
There are marked racial/ethnic disparities in breast cancer mortality. Cultural racism, expressed through societal norms, stereotypes, and implicit biases, may contribute. Using SEER data (2018-2020) and a previously validated state-level multidimensional latent measure (the cultural racism factor, CRF), we evaluated associations between CRF and risk of death using Cox proportional hazards models with state as random effect. Among 225,991 patients (63% NH White, 12% NH Black, 16% Hispanic), patients in higher CRF states experienced 8% higher risk of death per unit increase in CRF (aHR=1.08; 95% CI: 1.05-1.11). NH Black women exhibited a pattern suggestive of early elevated mortality risk that attenuated over follow-up.
Using SEER data on 225,991 breast-cancer patients (12% non-Hispanic Black) and a validated state-level cultural racism factor (CRF), the authors find each unit increase in state-level cultural racism is associated with an 8% higher adjusted risk of death (aHR 1.08), strongest in the first year of follow-up. Results support the argument that population-level cultural racism — not just interpersonal bias — shapes breast-cancer survival outcomes.