Abstract B121: Neighborhood socioeconomic status and obesity-related cancer mortality among postmenopausal women: A secondary analysis from the Women’s Health Initiative

Abstract

In the United States, approximately 282,000 cancer deaths occur annually among women aged ≥30 years, with an estimated 33% attributable to obesity-related cancers (ORCs). Overall, 41% of female cancer deaths are linked to modifiable lifestyle factors, including smoking (24.4%), excess body weight (8.2%), alcohol intake (3.6%), poor diet quality (3.4%), and physical inactivity (2-3%). The neighborhood environment represents a key upstream, policy-relevant determinant of cancer outcomes, with approximately one quarter of cancer mortality attributable to neighborhood-level social determinants. We therefore examined the association between neighborhood socioeconomic status (nSES) and ORC mortality among postmenopausal women in the Women’s Health Initiative (WHI). The WHI enrolled 161,808 postmenopausal, aged 50-79 across 40 U.S. clinical centers from 1993-1998, with follow-up through December 31, 2024. ORCs include the following 13 cancer types: breast (postmenopausal), colon and rectum, corpus uteri, thyroid, esophageal adenocarcinoma, gastric cardia, liver, gallbladder, pancreas, ovary, and kidney (renal cell); meningioma; and the hematologic malignancy, multiple myeloma. Less-common ORCs (lcORC) excluded breast and colorectal cancers. Baseline residential addresses were geocoded and linked to U.S. Census and American Community Survey data to derive nSES z-scores reflecting neighborhood economic and educational advantage. Multistate semi-Markov models estimated all-cause and cause-specific mortality after incident ORC or lcORC, adjusting for demographic, lifestyle, clinical covariates and time-varying variables. Effect modification was examined using cross-product interactions between nSES and smoking, race/ethnicity, U.S. region, and household income. Among an analytical cohort of 134,573 cancer-free participants (mean age 63.3 years), there were 54,228 all-cause deaths, 6,155 ORC-specific deaths, and 3,624 lcORC-specific deaths. Higher nSES was associated with lower all-cause mortality following any incident ORC (hazard ratio [HR]: 0.985; 95% confidence interval [CI]: 0.982–0.989) and lcORC (cause-specific HR [CSHR]: 0.977; 95% CI: 0.976–0.979) and with lower ORC-specific mortality after any ORC (CSHR: 0.984; 95% CI: 0.978-0.989) or lcORC (HR: 0.985; 95% CI: 0.977-0.993). Associations remained robust after adjustment for household income. No significant effect modification was observed. Among postmenopausal women, higher neighborhood education and economic advantage was associated with lower all-cause, ORC- and lcORC-specific mortality, independent of individual-level household income. The neighborhood effect may be partly driven through obesity linked pathways. Nonetheless, our findings suggest neighborhood economic and education advantage may have an independent role that contributes to structural cancer inequities and underscore the importance of multilevel intervention strategies targeting upstream neighborhood conditions, alongside individual risk factors. Margaret S. Pichardo, Chenhao (Gary) Lu, Leah Jager, Tania Y. Peña-Ortiz, Rowan T. Chlebowski, Rebecca A. Nelson, Lauren Hale, Su Yon Jung, Hailey R. Banack, Paola Filgrana, Oluwadamilola M. Fayanju. Neighborhood socioeconomic status and obesity-related cancer mortality among postmenopausal women: A secondary analysis from the Women’s Health Initiative [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr B121.