Racial and Ethnic Disparities in Cancer Mortality and Mediating Effects of Sociodemographic, Clinicopathologic, and Treatment Factors.

IF 2.4 3区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Journal of Racial and Ethnic Health Disparities Pub Date : 2025-09-25 DOI:10.1007/s40615-025-02634-z

Olajumoke A Olateju, Hassan E Arekemase, Hemalkumar B Mehta, Ahizechukwu C Eke, Chan Shen, J Douglas Thornton

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引用次数: 0

Abstract

Background: To evaluate the associations between race/ethnicity and cancer-specific and all-cause mortality and to explore potential mediating factors.

Methods: We identified patients diagnosed with lung (22,866), colorectal (13,382), melanoma (6894), prostate (22,922), and breast (133,366) cancers between 2010 and 2019 from the Texas Cancer Registry. Differences in mortality risk among non-Hispanic Blacks, Asian American/Native Hawaiian/Pacific Islanders (AANHPI), and Hispanics compared to non-Hispanic Whites were estimated using Cox proportional hazard and restricted mean survival time analyses. Mediation analysis was conducted to quantify the contributions of socioeconomic, clinicopathologic, and treatment-related factors to observed mortality differences.

Results: Racial/ethnic disparities in survival were observed across all cancers, with the smallest disparity for lung cancer and the largest for melanoma and breast cancer. In age-and-sex-adjusted models, Blacks had higher mortality risks for all cancers observed. Hispanics showed higher mortality risks for non-small cell lung cancer, melanoma, and breast cancer, while AANHPIs had lower mortality risks for lung and breast cancer. After adjusting for demographic, clinical, and treatment factors, Blacks still had significantly higher mortality risks for melanoma (HR = 1.63, 95% CI = 1.49-1.70) and breast cancer (HR = 1.19, 95% CI = 1.09-1.30). Socioeconomic and clinicopathologic factors were major mediators of racial/ethnic disparities, accounting for 56.71% of the difference in melanoma mortality and 54.10% in breast cancer mortality between Blacks and Whites.

Conclusions: Racial/ethnic disparities in cancer outcomes persist, particularly for melanoma and breast cancer among Black patients. Interventions promoting equity in cancer outcomes should be tailored by cancer type and take a multidisciplinary approach, integrating both social and biological factors to address disparities effectively.

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癌症死亡率的种族差异及社会人口学、临床病理和治疗因素的中介作用。

背景：评估种族/民族与癌症特异性和全因死亡率之间的关系，并探讨潜在的中介因素。方法：我们从德克萨斯州癌症登记处（Texas Cancer Registry）收集了2010年至2019年间诊断为肺癌（22,866例）、结直肠癌（13,382例）、黑色素瘤（6894例）、前列腺癌（22,922例）和乳腺癌（133,366例）的患者。非西班牙裔黑人、亚裔美国人/夏威夷原住民/太平洋岛民（AANHPI）和西班牙裔与非西班牙裔白人的死亡风险差异采用Cox比例风险和限制平均生存时间分析进行估计。进行中介分析以量化社会经济、临床病理和治疗相关因素对观察到的死亡率差异的贡献。结果：在所有癌症中都观察到种族/民族生存差异，肺癌差异最小，黑色素瘤和乳腺癌差异最大。在年龄和性别调整后的模型中，观察到的所有癌症中，黑人的死亡率都更高。拉美裔人患非小细胞肺癌、黑色素瘤和乳腺癌的死亡率较高，而aanhpi人患肺癌和乳腺癌的死亡率较低。在调整了人口统计学、临床和治疗因素后，黑人患黑色素瘤（HR = 1.63, 95% CI = 1.49-1.70）和乳腺癌（HR = 1.19, 95% CI = 1.09-1.30）的死亡风险仍显著较高。社会经济和临床病理因素是种族/民族差异的主要中介因素，黑人和白人之间黑色素瘤死亡率差异的56.71%和乳腺癌死亡率差异的54.10%。结论：癌症预后的种族差异仍然存在，尤其是黑人患者的黑色素瘤和乳腺癌。促进癌症结局公平的干预措施应根据癌症类型量身定制，并采取多学科方法，整合社会和生物因素，以有效解决差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Racial and Ethnic Health Disparities PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

7.30

自引率

5.10%

发文量

263

期刊介绍： Journal of Racial and Ethnic Health Disparities reports on the scholarly progress of work to understand, address, and ultimately eliminate health disparities based on race and ethnicity. Efforts to explore underlying causes of health disparities and to describe interventions that have been undertaken to address racial and ethnic health disparities are featured. Promising studies that are ongoing or studies that have longer term data are welcome, as are studies that serve as lessons for best practices in eliminating health disparities. Original research, systematic reviews, and commentaries presenting the state-of-the-art thinking on problems centered on health disparities will be considered for publication. We particularly encourage review articles that generate innovative and testable ideas, and constructive discussions and/or critiques of health disparities.Because the Journal of Racial and Ethnic Health Disparities receives a large number of submissions, about 30% of submissions to the Journal are sent out for full peer review.