三阴性乳腺癌女性的种族经济隔离、治疗和结局。

IF 3.7 3区 医学 Q2 ONCOLOGY
Stanton Davis, Min Lian, Graham A Colditz, Kia L Davis, James Struthers, Ying Liu
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引用次数: 0

摘要

背景:我们之前证明了非西班牙裔黑人(NHB)和非西班牙裔白人(NHW)三阴性乳腺癌(TNBC)妇女在治疗和死亡率方面的差异。居住隔离对TNBC治疗和结果的影响尚不清楚。方法:使用监测、流行病学和最终结果数据集,我们确定了2010-2015年诊断为TNBC的NHB和NHW妇女,并随访至2016年。县级种族化的经济隔离是用极端集中指数来衡量的。采用多水平Cox回归和多水平logistic回归核算县级聚类,计算风险比(hr)和优势比(ORs)。结果:25217例患者中,25.6%为NHB。与高收入NHW居民最集中县(最特权县)的患者相比,低收入NHW居民最集中县(最贫困县)的患者乳腺癌特异性死亡风险显著更高(HR=1.14, 95% CI 1.01-1.30;p趋势=0.12),总死亡率(HR=1.15, 95% CI 1.02-1.29;p趋势=0.06),晚期诊断(OR=1.15, 95% CI 1.01-1.32;Ptrend = 0.03)。总体而言,28.2%、24.5%和18.3%的NHB患者乳腺癌死亡率、总死亡率和晚期诊断的超额风险(与NHW患者相比)可由居住隔离解释。居住隔离和治疗之间没有明显的联系。结论:生活在最贫困和最优越的社区与TNBC早期发现和生存的可能性较低相关,这导致了nhb和nhw之间TNBC结局的差异。影响:这突出了以低收入非裔美国人为主的社区进行乳腺癌筛查的重要性,并阐明了隔离与TNBC预后之间的联系途径。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Racialized Economic Segregation, Treatment and Outcomes in Women with Triple-Negative Breast Cancer.

Background: We previously demonstrated differences in treatment and mortality between non-Hispanic Black (NHB) and non-Hispanic White (NHW) women with triple-negative breast cancer (TNBC). The impact of residential segregation on TNBC treatment and outcomes remains unknown.

Methods: We identified NHB and NHW women with TNBC diagnosed from 2010-2015 and followed through 2016, using the Surveillance, Epidemiology, and End Results dataset. County-level racialized economic segregation was measured using the Index of Concentration at the Extremes. Multilevel Cox regression and multilevel logistic regression accounting for county-level clustering were used to calculate hazard ratios (HRs) and odds ratios (ORs).

Results: Of 25217 patients, 25.6% were NHB. Compared with patients in counties with the highest concentration of high-income NHW residents (most privileged), patients in counties with the highest concentration of low-income NHB residents (most deprived) had significantly higher risks of breast cancer-specific mortality (HR=1.14, 95% CI 1.01-1.30; Ptrend=0.12), overall mortality (HR=1.15, 95% CI 1.02-1.29; Ptrend=0.06), and late-stage diagnosis (OR=1.15, 95% CI 1.01-1.32; Ptrend=0.03). Overall, 28.2%, 24.5%, and 18.3% of excess risks of breast cancer mortality, overall mortality, and late-stage diagnosis in NHB (vs NHW) patients were explained by residential segregation. There was no significant association between residential segregation and treatment.

Conclusions: Living in the most deprived vs privileged neighborhoods was associated with lower likelihoods of early detection and survival of TNBC, contributing to TNBC outcome disparities between NHBs and NHWs.

Impact: This highlights the importance of breast cancer screening for neighborhoods with predominantly low-income NHB residents and elucidating the pathways linking segregation to TNBC prognosis.

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来源期刊
Cancer Epidemiology Biomarkers & Prevention
Cancer Epidemiology Biomarkers & Prevention 医学-公共卫生、环境卫生与职业卫生
CiteScore
6.50
自引率
2.60%
发文量
538
审稿时长
1.6 months
期刊介绍: Cancer Epidemiology, Biomarkers & Prevention publishes original peer-reviewed, population-based research on cancer etiology, prevention, surveillance, and survivorship. The following topics are of special interest: descriptive, analytical, and molecular epidemiology; biomarkers including assay development, validation, and application; chemoprevention and other types of prevention research in the context of descriptive and observational studies; the role of behavioral factors in cancer etiology and prevention; survivorship studies; risk factors; implementation science and cancer care delivery; and the science of cancer health disparities. Besides welcoming manuscripts that address individual subjects in any of the relevant disciplines, CEBP editors encourage the submission of manuscripts with a transdisciplinary approach.
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