Integrating access to care and tumor patterns by race and age in the Carolina Breast Cancer Study, 2008-2013
Integrating access to care and tumor patterns by race and age in the Carolina Breast Cancer Study, 2008-2013
复制标题
DOI：
10.1007/s10552-019-01265-0
复制
发表时间：
2020-01-16
影响因子：
2.3
通讯作者：
Troester, Melissa A.
中科院分区：
文献类型：
--
作者：
Emerson, Marc A.;Golightly, Yvonne M.;Troester, Melissa A.
由于疾病异质性、共病以及影响获得护理的因素的范围，了解不同种族和年龄的乳腺癌死亡率差异是复杂的。重要的是要了解这些因素如何在患者体内组合在一起。方法我们使用2010年行为风险因素监测研究，比较了卡罗莱纳乳腺癌研究第3期（CBCS 3，2008-2013）与北卡罗来纳州的社会经济地位（SES）和合并症因素。此外，我们使用CBCS 3数据的潜在类别分析来识别SES/合并症、护理障碍和肿瘤特征的协变量模式，并使用多项logistic回归检查其与种族和年龄的相关性。结果CBCS 3参与者的主要SES和共病模式与该州的模式基本相似。根据SES/合并症、护理障碍和肿瘤特征确定潜在类别，这些类别因种族和年龄而异。与白色女性相比，黑人女性的SES较低（比值比（OR）6.3，95%置信区间（CI）5.2，7.8），护理障碍较多（OR 5.6，95% CI 3.9，8.1），并且有几个聚集的肿瘤侵袭性特征。与老年女性相比，年轻女性具有更高的SES（OR 0.5，95% CI 0.4，0.6），更多的护理障碍（OR 2.1，95% CI 1.6，2.9）和聚集的肿瘤侵袭性特征。结论CBCS 3在可比因素上具有北卡罗来纳州的代表性。获得护理和肿瘤特征的模式与种族和年龄交织在一起，这表明解决差异的干预措施需要针对获得和生物学。
Purpose Understanding breast cancer mortality disparities by race and age is complex due to disease heterogeneity, comorbid disease, and the range of factors influencing access to care. It is important to understand how these factors group together within patients. Methods We compared socioeconomic status (SES) and comorbidity factors in the Carolina Breast Cancer Study Phase 3 (CBCS3, 2008-2013) to those for North Carolina using the 2010 Behavioral Risk Factor Surveillance Study. In addition, we used latent class analysis of CBCS3 data to identify covariate patterns by SES/comorbidities, barriers to care, and tumor characteristics and examined their associations with race and age using multinomial logistic regression. Results Major SES and comorbidity patterns in CBCS3 participants were generally similar to patterns in the state. Latent classes were identified for SES/comorbidities, barriers to care, and tumor characteristics that varied by race and age. Compared to white women, black women had lower SES (odds ratio (OR) 6.3, 95% confidence interval (CI) 5.2, 7.8), more barriers to care (OR 5.6, 95% CI 3.9, 8.1) and several aggregated tumor aggressiveness features. Compared to older women, younger women had higher SES (OR 0.5, 95% CI 0.4, 0.6), more barriers to care (OR 2.1, 95% CI 1.6, 2.9) and aggregated tumor aggressiveness features. Conclusions CBCS3 is representative of North Carolina on comparable factors. Patterns of access to care and tumor characteristics are intertwined with race and age, suggesting that interventions to address disparities will need to target both access and biology.