Differences in Breast Cancers Among American Indian/Alaska Native and non-Hispanic Whites in the USA.

IF 3.2 3区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Journal of Racial and Ethnic Health Disparities Pub Date : 2024-08-01 Epub Date: 2023-07-11 DOI:10.1007/s40615-023-01704-4

Anu G Gaba, Li Cao, Rebecca J Renfrew, DeAnn Witte, Janet M Wernisch, Abe E Sahmoun, Sanjay Goel, Kristi A Egland, Ross D Crosby

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引用次数: 0

Abstract

Importance: Breast cancer (BC) death rates have not improved for American Indian/Alaska Native (AI/AN) women, whereas, it has significantly decreased for non-Hispanic White (White) women.

Objective: Delineate the differences in patient and tumor characteristics among AI/AN and Whites with BC, and its impact on age and stage at diagnosis as well as overall survival (OS).

Methods: Hospital-based, cohort study using the National Cancer Database to identify female AI/AN and Whites diagnosed with BC between the years 2004 and 2016.

Results: BC in 6866 AI/AN (0.3%) and 1,987,324 Whites (99.7%) were studied. The median age at diagnosis was 58 for AI/AN and 62 for Whites. AI BC patients traveled double the distance for treatment, lived in lower median income zip codes, had a higher percentage of uninsured, higher comorbidities, lower percentage of Stage 0/I, larger tumor size, greater number of positive lymph nodes, higher proportion of triple negative and HER2-positive BC than Whites. All the above comparisons were significant, p<0.001. Association between patient/tumor characteristics with age and stage at diagnosis was not significantly different between AI/AN and Whites. Unadjusted OS was worse for AI/AN as compared to Whites (HR=1.07, 95% CI=1.01-1.14, p=0.023). After adjustment of all covariates, OS was not different (HR=1.038, 95%CI=0.902-1.195, p=0.601).

Conclusion: There were significant differences in patient/tumor characteristics among AI/AN and White BC which adversely impacted OS in AI/AN. However, when adjusted for various covariates, the survival was similar, suggesting that the worse survival in AI/AN is mostly the impact of known biological, socio-economic, and environmental determinants of health.

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美国印第安人/阿拉斯加原住民与非西班牙裔白人患乳腺癌的差异。

重要性：美国印第安人/阿拉斯加原住民（AI/AN）妇女的乳腺癌（BC）死亡率没有改善，而非西班牙裔白人（White）妇女的乳腺癌死亡率却显著下降：方法：基于医院的队列研究，利用国家癌症数据库识别2004年至2016年期间确诊为BC的美国印第安/阿拉斯加原住民和白人女性患者和肿瘤特征的差异，及其对确诊时的年龄和分期以及总生存率（OS）的影响：研究对象包括6866名美国原住民/印第安人（0.3%）和1987324名白人（99.7%）。美国原住民/印第安人确诊时的中位年龄为 58 岁，白人为 62 岁。与白人相比，亚裔 BC 患者接受治疗的路程长一倍，居住在收入中位数较低的邮政编码中，无保险的比例较高，合并症较多，0/I 期的比例较低，肿瘤体积较大，阳性淋巴结数量较多，三阴性和 HER2 阳性 BC 的比例较高。上述所有比较结果均具有显著性，p结论：亚裔美国人和白人 BC 患者/肿瘤特征存在明显差异，这对亚裔美国人的 OS 有不利影响。然而，在对各种协变量进行调整后，存活率相似，这表明亚裔美国人/印第安人的存活率较低主要是受已知的生物、社会经济和环境健康决定因素的影响。

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.