Award Date


Degree Type


Degree Name

Master of Public Health (MPH)


Environmental and Occupational Health

First Committee Member

Dr. Paulo Pinheiro

Second Committee Member

Dr. Brian Labus

Third Committee Member

Dr. Rachelle Rodriguez

Fourth Committee Member

Dr. Carrie Gillis

Number of Pages



Studies on mortality from postmenopausal breast cancer (PMBC) by education level have not shown consistent results among US women. For US Asians, often seen as a “model” minority in terms of affluence and education this relationship has never been studied despite PMBC being the most common cancer in the country.

We analyzed 2008-2012 California Vital Statistics data and population data from the American Community Survey 2012 to compute age and education adjusted mortality ratios using negative binomial regression model for White (as a reference category) and Asian women. In total 3,277,106 (80%) White women and 852,376 (20%) Asian women died of breast cancer (ICD-10 code C50) during the study period. Educational attainment was positively associated with mortality from PMBC both in White and Asian women. However, for Whites those who attended college were 11% more likely to die of PMBC [1.1 (C.I- 1.037-1.188)], While Asians were 2.6 times more likely to die from PMBC [2.6 (C.I.-2.3-3.1)]. Asians showed considerable heterogeneity in the effect of education on PMBC mortality with Filipino women [2.8 (C.I. - 2.0- 4.0)] showing higher differential according to education level compared Chinese women [1.9 (C.I. 1.5-2.5)]. At all education levels, Whites had a higher risk of dying due to breast cancer than Asians.

Since survival has been shown to be higher among women with higher education across all races, our mortality findings can only be explained by a true increased risk of PMBC among highly educated women. Lower parity, old age at first birth, higher uptake of hormone replacement therapy and negative acculturation for Asians are possible causes. More studies are necessary to further clarify the etiology of this important cause of death with a focus on education level and socio-economic status.


Biostatistics | Epidemiology

File Format


Degree Grantor

University of Nevada, Las Vegas




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