Subjective social status, race, and metabolic syndrome in women with breast cancer

Purpose To evaluate the association of subjective social status (SSS) with metabolic syndrome (MetS) severity and its potential contribution to racial health disparities in women with breast cancer. Methods Multicenter cross-sectional study (10 US hospitals) in women ( n = 1206) with primary diagnosis of invasive breast cancer received during Mar/2013–Feb/2020. Participants, self-identified as non-Hispanic White or Black, underwent physical and laboratory examinations and survey questions assessing socioeconomic parameters, medical history, and behavioral risks. SSS was measured with the 10-rung MacArthur scale. MetS severity was measured with a validated Z-Score. Generalized linear mixed modeling was used to analyze the associations. Missing data were handled using multiple imputation. Results Average age was 58 years. On average, the SSS of Black women, given equivalent level of income and education, was lower than the SSS of White women: 6.6 (6.1–7.0) vs 7.7 (7.54–7.79) among college graduates and 6.8 (6.4–7.2) vs 7.6 (7.5–7.8) among women in the high-income category (> $75,000). In multivariable analysis, after controlling for age, income, education, diet, and physical activity, increasing SSS was associated with a decrease in MetS-Z score, − 0.10 (− 0.16 to − 0.04) per every 2 rung increase in the MacArthur scale. Conclusion Black women with breast cancer rank their SSS lower than White women with breast cancer do at each level of income and education. As SSS is strongly associated with MetS severity these results identify potentially modifiable factors that contribute to racial disparities.