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.

Available for download on Tuesday, May 01, 2018