Hypertension is an independent predictor of survival disparity between African-American and white breast cancer patients
Hypertension is an independent predictor of survival disparity between African-American and white breast cancer patients
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DOI：
10.1002/ijc.24054
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发表时间：
2009-03-01
影响因子：
6.4
通讯作者：
Esserman, Laura
中科院分区：
文献类型：
--
作者：
Braithwaite, Dejana;Tammemagi, C. Martin;Esserman, Laura
本研究的目的是确定是否合并症，或预先存在的条件，可以解释一些非洲裔美国人和白色乳腺癌患者之间的生存差异。对1973年至1986年期间诊断为乳腺癌的416名非洲裔美国妇女和838名白色妇女进行了一项历史队列研究，并在凯撒永久北方加州医疗保健计划中随访至1999年。从病历、监测、流行病学和最终结果、北方加州癌症中心登记处获得关于合并症、肿瘤特征和乳腺癌治疗的信息，并采用多项考克斯比例风险回归分析合并症与生存率之间的关系。平均随访9年，非裔美国人的总体粗死亡率高于白人：分别为165（39.7%）和279（33.3%）。当年龄、种族、肿瘤特征和乳腺癌治疗得到控制时，高血压的存在与全因生存率相关[风险比（HR）= 1.33，95%置信区间（CI）1.07-1.67]，高血压占该结局种族差异的30%。高血压增强的Charlson合并症指数是所有原因（HR = 1.32，95%CI 1.18-1.49）、竞争原因（HR = 1.52，95%CI 1.32-1.76）和乳腺癌特异性原因（HR = 1.18，95%CI 1.03-1.35）生存率的显著预测因子。总之，高血压与非裔美国人和白色乳腺癌患者之间的生存差异有关，具有预后意义。如果我们的研究结果在当代人群中得到重复，可能有必要将高血压纳入Charlson合并症指数和其他合并症指标。(C)2008 Wiley-Liss，Inc.
The objective of this study was to determine whether comorbidity, or pre-existing conditions, can account for some of the disparity in survival between African-American and white breast cancer patients. A historical cohort study was conducted of 416 African-American and 838 white women diagnosed with breast cancer between 1973 and 1986, and followed through 1999 in the Kaiser Permanente Northern California Medical Care Program. Information on comorbidity, tumor characteristics and breast cancer treatment was obtained from medical records, and Surveillance, Epidemiology and End Results, Northern California Cancer Center Registry, Associations between comorbidity and survival were analyzed with multiple Cox proportional hazards regression. Over a mean follow-up of 9 years, African Americans had higher overall crude mortality than whites: 165 (39.7%) versus 279 (33.3%), respectively. When age, race, tumor characteristics an breast cancer treatment were controlled, the presence of hypertension was associated with all cause survival [hazard ratio (HR) = 1.33, 95% confidence intervals (CI) 1.07-1.67] and it accounted for 30% of racial disparity in this outcome. Hypertension-augmented Charlson Comorbidity Index was a significant predictor of survival from all causes (HR = 1.32, 95%CI 1.18-1.49), competing causes (HR = 1.52, 95%CI 1.32-1.76) and breast cancer specific causes (HR = 1.18, 95%CI 1.03-1.35). In conclusion, hypertension has prognostic significance in relation to survival disparity between African-American and white breast cancer patients. If our findings are replicated in contemporary cohorts, it may be necessary to include hypertension in the Charlson Comorbidity Index and other comorbidity measures. (C) 2008 Wiley-Liss, Inc.