Racial, Ethnic, and Socioeconomic Disparities in Meeting Physical Activity Guidelines among Female Breast Cancer Survivors in the United States

Abstract

Background: Cancer survivors show low physical activity participation rates in the United States. However, there are limited national-level data on disparities in the prevalence of meeting physical activity guidelines among women with and without breast cancer. We aimed to evaluate national-level trends in meeting physical activity guidelines across demographic and socioeconomic characteristics of breast cancer survivors and women without cancer.

Methods: Data for women ≥35 years of age with and without breast cancer were obtained from the 2004 to 2018 National Health Interview Survey. We used National Health Interview Survey sample weights to generate national-level prevalence estimates and calculate absolute and relative indices of disparity for breast cancer survivors and women without cancer meeting aerobic (150 minutes/week) and muscle-strengthening guidelines (2 sessions/week) stratified by demographic (e.g., race/ethnicity) and socioeconomic (e.g., homeownership) characteristics.

Results: We included 5,845 breast cancer survivors and 160,162 women without cancer. The weighted percentage of breast cancer survivors meeting aerobic guidelines was 37.7% compared with 40.9% of women without cancer. Fewer women met muscle-strengthening guidelines. There were lower proportions of women who were younger (<50-years), were non-Hispanic Black, were Hispanic, worked 35+ hours/week, or rented their home among breast cancer survivors meeting aerobic guidelines compared with women without cancer meeting aerobic guidelines.

Conclusions: Breast cancer survivors were less likely to meet physical activity guidelines compared with women without cancer. Demographic and socioeconomic disparities may exist among breast cancer survivors and women without cancer meeting physical activity guidelines.

Impact: Targeted interventions may be necessary to address low physical activity participation among breast cancer survivors.

Figure 1.

Inclusion/exclusion criteria for breast cancer survivors. This figure depicts the inclusion and exclusion criteria used for breast cancer survivors. Our final analytic sample consisted of 5,845 female adults ages 35+, were diagnosed with breast cancer as the primary cancer, had no other cancer besides skin cancer, and had no missing physical activity variables.

Figure 2.

Percentage of breast cancer survivors who met aerobic guidelines and/or muscle-strengthening guidelines. A, The percentage of breast cancer survivors who met aerobic guidelines, stratified by age. B, The percentage of breast cancer survivors who met muscle-strengthening guidelines, stratified by age. C, The percentage of breast cancer survivors who met aerobic guidelines, stratified by race/ethnicity. D, The percentage of breast cancer survivors who met muscle-strengthening guidelines, stratified by race/ethnicity. E, The percentage of breast cancer survivors who met aerobic guidelines, stratified by education level. F, The percentage of breast cancer survivors who met muscle-strengthening guidelines, stratified by education level. G, The percentage of breast cancer survivors who met aerobic guidelines, stratified by the ratio of income to poverty threshold. H, The percentage of breast cancer survivors who met muscle-strengthening guidelines, stratified by the ratio of income to poverty threshold. Breast cancer survivors met aerobic guidelines if they participated in the equivalent of ≥150 minutes per week of activity and met muscle-strengthening guidelines if they participated in two or more strength training sessions per week. Percentages represent weighted percentages among breast cancer survivors, calculated as the ratio of the count of a single cell to the total count for the row that contains that cell, weighted by survey year. Ratios are represented as percentages. *, categories were suppressed when the number of individuals in any cell was less than 10 to reduce the likelihood of a breach of confidentiality. AI/AN, American Indian/Alaska Native; GED, general educational development; HS, high school.