Does socioeconomic status account for racial and ethnic disparities in childhood cancer survival?
Does socioeconomic status account for racial and ethnic disparities in childhood cancer survival?
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DOI：
10.1002/cncr.31560
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发表时间：
2018-10-15
期刊：
影响因子：
6.2
通讯作者：
Osypuk, Theresa L.
中科院分区：
文献类型：
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作者：
Kehm, Rebecca D.;Spector, Logan G.;Osypuk, Theresa L.
背景 对于许多儿童癌症，与非西班牙裔白人相比，非西班牙裔黑人和西班牙裔的生存率较低，这可能归因于潜在的社会经济因素。然而，之前的儿童癌症生存研究尚未正式测试社会经济地位（SES）的中介作用。本研究应用中介方法来量化 SES 在儿童癌症生存的种族/民族差异中的作用。方法 本研究使用了来自监测、流行病学和最终结果 18 数据库的基于人群的癌症生存数据，针对 2000 年至 2011 年 0 至 19 岁期间被诊断出的黑人、白人和西班牙裔儿童 (n=31,866)。估计了黑人、白人和西班牙裔白人的死亡率风险比和 95% 置信区间，并根据年龄、性别和诊断时的阶段进行了调整。逆比值加权法用于测试 SES 的中介作用，并使用经过验证的人口普查区综合指数进行测量。结果结论对于多种儿童癌症，白人比黑人和西班牙裔有显着的生存优势。 SES 显着介导急性淋巴细胞白血病、急性髓细胞白血病、神经母细胞瘤和非霍奇金淋巴瘤的种族/族裔生存关联； SES 将黑人与白人的种族/族裔与生存之间的原始关联分别降低了 44%、28%、49% 和 34%，将西班牙裔与白人相比分别降低了 31%、73%、48% 和 28%（（对数风险比总效应 - 对数风险比直接效应）/对数风险比总效应）。结论 SES 显着调节多种癌症的种族/族裔儿童癌症生存差异。然而，对于某些癌症，SES 解释的种族/族裔生存关联总比例在黑人-白人和西班牙裔-白人之间的比较有所不同，这表明其他因素的调节在不同群体之间存在差异。 (C) 2018 美国癌症协会
Background For many childhood cancers, survival is lower among non-Hispanic blacks and Hispanics in comparison with non-Hispanic whites, and this may be attributed to underlying socioeconomic factors. However, prior childhood cancer survival studies have not formally tested for mediation by socioeconomic status (SES). This study applied mediation methods to quantify the role of SES in racial/ethnic differences in childhood cancer survival. Methods This study used population-based cancer survival data from the Surveillance, Epidemiology, and End Results 18 database for black, white, and Hispanic children who had been diagnosed at the ages of 0 to 19 years in 2000-2011 (n=31,866). Black-white and Hispanic-white mortality hazard ratios and 95% confidence intervals, adjusted for age, sex, and stage at diagnosis, were estimated. The inverse odds weighting method was used to test for mediation by SES, which was measured with a validated census-tract composite index. Results ConclusionsWhites had a significant survival advantage over blacks and Hispanics for several childhood cancers. SES significantly mediated the race/ethnicity-survival association for acute lymphoblastic leukemia, acute myeloid leukemia, neuroblastoma, and non-Hodgkin lymphoma; SES reduced the original association between race/ethnicity and survival by 44%, 28%, 49%, and 34%, respectively, for blacks versus whites and by 31%, 73%, 48%, and 28%, respectively, for Hispanics versus whites ((log hazard ratio total effect - log hazard ratio direct effect)/log hazard ratio total effect). Conclusions SES significantly mediates racial/ethnic childhood cancer survival disparities for several cancers. However, the proportion of the total race/ethnicity-survival association explained by SES varies between black-white and Hispanic-white comparisons for some cancers, and this suggests that mediation by other factors differs across groups. (C) 2018 American Cancer Society