Date of Award


Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Ike S Okosun

Second Advisor

Ruiyan Luo


INTRODUCTION: Breast cancer and Type 2 diabetes Mellitus are two chronic conditions that impact the lifespan and quality of life of women. Both diabetes and breast cancer have a disproportionate impact on African-American/Black women and it is reasonable to believe that Biological mechanisms or treatments for this co-morbid condition may have an antagonistic effect and impact the individual’s risk of mortality.

AIM: This study aims to address whether pre-existing diabetes occurs at different rates among African-American/Black women with breast cancer than White women, and if diabetes and race are associated with higher all-cause and breast cancer specific mortality among women.

METHODS: The US mortality linked data from the National Health Interview Survey (NHIS) 2006-2009, was used in the analysis. Cox proportional hazard regression was used to model and estimate the adjusted and unadjusted hazard ratios of the identified risk factors on mortality.

RESULTS: Diabetes and pre-existing diabetes (33.20% & 52.24%) were more prevalent among Black women with breast Cancer than Whites (13.87% & 39.82%). African-Americans experienced increased breast cancer specific mortality (HR: 1.564, 1.465-1.669 95%CI) than whites. Diabetes and Pre-diabetes were associated with increased risk of all-cause (HR: 1.60 & 1.329) and breast cancer specific mortality (HR: 1.37 & 1.177). Diabetes and pre-diabetes impacted all-cause mortality among Africans-Americans (HR: 15.757 & 13.658) differentially than Whites (HR: 1.377 & 1.079). Similarly, Diabetes and pre-diabetes impacted breast cancer-specific mortality among African-Americans (HR: 10.891 & 7.696) differentially than whites (HR: 1.125 & 0.850)

DISCUSSION: Diabetes and breast cancer was a more common comorbidity among Black women than Whites. Diabetes was associated with increased risk of all cause and breast cancer specific death. Race was found to have a significantly increase breast cancer specific mortality among diabetic individuals. Increased diabetes prevalence among Blacks may partially explain their higher breast cancer mortality rates.