Abstract

Background: Breast cancer mortality rates exhibit notable variations across ethnic groups in Israel. While previous studies have identified disparities between Jewish and Muslim Arab women, the complex interplay of sociodemographic factors influencing these differences remains incompletely understood. This study aims to elucidate the role of sociodemographic and reproductive factors in breast cancer mortality patterns among these populations.

Methods: A retrospective cohort study was conducted encompassing 817,445 Israeli women (743,090 Jewish and 74,355 Muslim Arab) born between 1940-1960, with a 30-year follow-up period (1990-2020). Data were obtained from the Israeli Central Bureau of Statistics. Breast cancer mortality rates were analyzed in relation to parity, socioeconomic status (SES), locality size, and country of origin using multivariable Cox regression models. The analysis incorporated comprehensive adjustment for potential confounders and evaluation of interaction effects between ethnicity and key variables.

Results: Muslim Arab women demonstrated lower crude breast cancer mortality rates compared to Jewish women (Age-adjusted Hazard Ratio [AHR] = 0.866, 99% CI: 0.778-0.964). However, these disparities were attenuated after adjustment for sociodemographic variables. Among Muslim Arab women, high parity (>3 children) exhibited a protective effect (AHR = 0.751, 99% CI: 0.609-0.927), while higher SES was associated with increased mortality risk (High SES: AHR = 1.591, 99% CI: 1.052-2.631; Medium SES: AHR = 1.309, 99% CI: 1.015-1.796). In contrast, among Jewish women, parity showed no significant association with mortality, while residence in larger localities (AHR = 1.217, 99% CI: 1.115-1.329) and medium SES (AHR = 1.146, 99% CI: 1.064-1.235) were associated with higher mortality rates.

Conclusions: This study reveals distinct patterns in the relationship between sociodemographic factors and breast cancer mortality across ethnic groups in Israel. The differential impact of parity and SES between populations underscores the necessity for culturally-tailored interventions. These findings highlight the importance of developing targeted prevention strategies that account for the unique risk profiles of different ethnic and socioeconomic groups, potentially informing more effective public health policies to address breast cancer mortality disparities