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Women from the National Cancer Institute Surveillance, Epidemiology, and End Results database \u226520 years of age, diagnosed with primary breast cancer between 2005 and 2014, and who survived at least 1 year (\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u00a036,711) were included. Participants were aggregated by their county of residence and linked to their American Community Survey 5\u2010year poverty estimates. Local Moran\u2019s I was used to categorize residential and surrounding county poverty environments as high or low using a mean cutoff. Multivariable\u2010adjusted negative binomial regression was used to evaluate mortality relative risk (MRR) and 95% CIs for the association between residential and surrounding county poverty on all\u2010cause mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Women in high\u2010poverty residential (Hr) counties had a 6% increase in death (MRR\u00a0=\u00a01.06; 95% CI, 1.01\u20131.10) compared to women in low\u2010poverty residential counties (Lr). Women surrounded by high\u2010poverty (Hs) counties had a 22% increase in death (MRR\u00a0=\u00a01.22; 95% CI, 1.13\u20131.31) compared to women surrounded by low\u2010poverty (Ls) counties. The combined MRR for women in Hr\u2010Hs, Lr\u2010Hs, and Hr\u2010Ls counties was 1.23 (95% CI, 1.13\u20131.33), 1.25 (95% CI, 1.02\u20131.51), and 1.08 (95% CI, 0.95\u20131.21), respectively, when compared to Lr\u2010Ls counties.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Poverty in the surrounding counties has a greater impact on mortality among survivors than residential county poverty alone. Incorporating poverty levels from both residential and surrounding counties can improve definitions of high\u2010 and low\u2010risk regions after a breast cancer diagnosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cncr.70414","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T05:21:59Z","timestamp":1777008119000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Poverty in the residential and surrounding counties and its impact on mortality in women with breast cancer"],"prefix":"10.1002","volume":"132","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1755-9957","authenticated-orcid":false,"given":"Ifeoma","family":"Nwigwe","sequence":"first","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramkrishnan 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