# Neighborhood disadvantage and multiple myeloma incidence in the Black Women’s Health Study

## TL;DR

Black women living in disadvantaged neighborhoods have a higher risk of developing multiple myeloma, suggesting that neighborhood conditions may contribute to health disparities.

## Contribution

This study is the first to link neighborhood disadvantage and socioeconomic status with multiple myeloma incidence in Black women.

## Key findings

- Women in high-disadvantage neighborhoods had a 48% higher MM risk compared to those in the least disadvantaged areas.
- Living in low socioeconomic status areas was associated with a 28% increased MM risk, though the result was less statistically significant.
- The study highlights the potential role of neighborhood-level factors in contributing to racial disparities in MM.

## Abstract

Black Americans have a >2-fold increased risk of multiple myeloma (MM) compared with other racial/ethnic groups. The underlying biological and environmental mechanisms contributing to this disparity remain poorly understood. Emerging evidence suggests that social and economic factors associated with neighborhoods may influence risk.

We evaluated associations between two neighborhood-level indices by measuring deprivation and socioeconomic status and MM within the Black Women’s Health Study—a prospective cohort of 59 000 Black women established in 1995. Participant addresses at baseline and over follow-up were geocoded and linked with United States Census Bureau data. We used Cox proportional hazards regression to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of neighborhood indices, categorized into quartiles, and MM incidence. Multivariable models were adjusted for age, body mass index, educational attainment, alcohol consumption, physical activity, cigarette smoking, and geographic region.

During follow-up through 2021, we identified 276 incident MM cases. In time-varying age-adjusted models, women living in areas of high disadvantage (vs lowest) and low socioeconomic status (vs highest) had a higher incidence of MM than women living in areas of privilege (multivariable HR: 1.48, 95% CI: 1.02, 2.13; HR: 1.28, 95% CI: 0.87, 1.90, respectively).

Black women living in neighborhoods of high concentrated disadvantage or low socioeconomic status have an increased MM risk. Future studies to identify specific neighborhood-level factors that might influence the risk of MM would be beneficial. Ultimately, community reinvestment may offer an opportunity to reduce the increasing burden of MM among Black women.