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Key Points Question How do all-cause mortality rates and racial inequities in rates vary across the 30 most populous US cities? Findings In this cross-sectional study of more than 26 million death records during a 10-year period, city mortality rates differed widely as did inequities between Black and White populations. Overall mortality rates improved in less than half of the 30 cities, and racial inequities worsened in more cities than in which they improved. Meaning Given the substantial variation in city-level mortality rates and racial inequities, cities need data specific to their jurisdiction to inform local health policy.

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Introduction Non-Latina black breast cancer patients experience a shorter survival from breast cancer than their non-Latina white counterparts. We compared breast cancer specific survival for the subset of black and white patients with estrogen and/or progesterone receptor positive tumors that are generally targeted with endocrine therapy. Methods Using data collected from a population-based cohort of breast cancer patients from Chicago, IL, Kaplan Meier survival curves and hazard functions were generated and proportional hazards models were estimated to determine the black/white disparity in time to death from breast cancer while adjusting for age at diagnosis, patient characteristics, treatment-related variables, and tumor grade and stage. Results In regression models, hazard of breast cancer death among ER/PR positive patients was at least 4 times higher for black than for white patients in all models tested. Notably, even after adjusting for stage at diagnosis, tumor grade, and treatment variables (including initiation of systemic adjuvant therapies), the hazard ratio for death from ER/PR positive breast cancer between black and white women was 4.39 (95% CI: 1.76, 10.9, p=0.001). Conclusions We observed a racial disparity in breast cancer survival for patients diagnosed with ER/PR positive tumors that did not appear to be due to differences in tumor stage, grade or therapy initiation in black patients, suggesting that there may be racial differences in the molecular characteristics of hormone receptor positive tumors, such that ER/PR positive tumors in black patients may be less responsive to standard treatments.