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We used synthetic and actual census tract data for California and actual data for New York State (NYS) to examine associations of small area socioeconomic factors with breast cancer prognosis and outcomes and to evaluate results obtained from synthetic versus actual data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrieved data on invasive, first primary breast cancers diagnosed between 2006 and 2017 in females ages\u2009\u2265\u200918 in California    \u00a0(\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009237,156) or NYS (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009149,789). We categorized into quintiles census tract-level exposures and used multivariable-adjusted multilevel logistic and Cox proportional hazards regression analyses to examine associations with stage, grade, subtype, and overall and cancer-specific survival. We conducted separate analyses for California and NYS and compared results from the two states and from synthetic and actual data for California.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Except for income inequality, greater disadvantage for each socioeconomic variable was statistically significantly associated with more advanced stage, higher grade, higher-risk subtypes, and poorer survival in both states. Synthetic and actual results for California were consistent in direction and statistical significance, but the synthetic data tended to overestimate associations with stage and underestimate associations with grade, subtype, and survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our results indicate that residence in more disadvantaged census tracts is associated with poorer breast cancer prognosis and outcomes. Associations were similar across two large, diverse states, and synthetic results approximated actual results for California. Additional work is needed to improve early diagnosis, care, and outcomes for individuals with breast cancer in disadvantaged areas.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10552-026-02152-1","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T07:48:18Z","timestamp":1773906498000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Census tract-level socioeconomic variables and breast cancer characteristics and outcomes in California and New York State"],"prefix":"10.1007","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2111-6227","authenticated-orcid":false,"given":"Margaret Gates","family":"Kuliszewski","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Baozhen","family":"Qiao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mandi","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria J.","family":"Schymura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tabassum","family":"Insaf","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"2152_CR1","doi-asserted-by":"publisher","first-page":"4160","DOI":"10.1002\/cncr.25427","volume":"116","author":"CM Booth","year":"2010","unstructured":"Booth CM, Li G, Zhang-Salomons J, Mackillop WJ (2010) The impact of socioeconomic status on stage of cancer at diagnosis and survival: a population-based study in Ontario, Canada. 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Accessed 21 Nov 2025"}],"container-title":["Cancer Causes &amp; Control"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10552-026-02152-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10552-026-02152-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10552-026-02152-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T04:11:20Z","timestamp":1775448680000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10552-026-02152-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,19]]},"references-count":48,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["2152"],"URL":"https:\/\/doi.org\/10.1007\/s10552-026-02152-1","relation":{},"ISSN":["0957-5243","1573-7225"],"issn-type":[{"value":"0957-5243","type":"print"},{"value":"1573-7225","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,19]]},"assertion":[{"value":"9 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The California data used for this project were de-identified and unable to be linked to individual patients and are therefore not human subjects research. 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