Neighborhood Disadvantage and Lung Cancer Incidence in Ever-Smokers at a Safety Net Health-Care System A Retrospective Study
Neighborhood Disadvantage and Lung Cancer Incidence in Ever-Smokers at a Safety Net Health-Care System A Retrospective Study
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DOI：
10.1016/j.chest.2019.11.033
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发表时间：
2020-04-01
期刊：
影响因子：
9.6
通讯作者：
Tarabichi, Yasir
中科院分区：
文献类型：
--
作者：
Adie, Yosra;Kats, Daniel J.;Tarabichi, Yasir
背景：社区环境对多种健康结果有影响，但社区环境与肺癌发病率之间的关系还没有得到足够详细的研究。这项研究的目的是了解在调整了个人吸烟暴露和其他危险因素后，社区条件是否与吸烟者的肺癌发病率独立相关。方法：从我们的学术社区卫生保健系统收集了19年的电子健康记录数据，收集了55岁的吸烟者队列。确定了患者的人口学特征和其他已知与肺癌相关的指标。在他们的索引访问中，患者地址被地理编码到人口普查区块组水平，以确定区域剥夺指数(ADI)，该指数来自美国社区调查的5年估计。多变量COX比例风险模型适用于评估ADI和肺癌诊断时间之间的关联。结果：本研究共纳入19867名男性受试者和21748名女性受试者。53%的患者是白人，38%是黑人，5%是西班牙裔。在这些人中，1149人患上了肺癌。在调整已知危险因素后，居住在最不利地区的患者与生活在最不利地区的患者相比，肺癌发病率显著增加(风险比，1.29；95%可信区间1.07-1.55)。结论：即使在调整个体变量时，人口普查得出的邻里条件估计与肺癌发病率也有很强的相关性。进一步研究邻里条件与肺癌之间的联系是有必要的。
BACKGROUND: Neighborhood circumstances have an influence on multiple health outcomes, but the association between neighborhood conditions and lung cancer incidence has not been studied in sufficient detail. The goal of this study was to understand whether neighborhood conditions are independently associated with lung cancer incidence in ever-smokers after adjusting for individual smoking exposure and other risk factors.METHODS: A cohort of ever-smokers aged >= 55 years was assembled from 19 years of electronic health record data from our academic community health-care system. Patient demographic characteristics and other measures known to be associated with lung cancer were ascertained. Patient addresses at their index visit were geocoded to the census block group level to determine the area deprivation index (ADI), drawn from 5-year estimates from the American Community Survey. A multivariate Cox proportional hazards model was fit to assess the association between ADI and time to lung cancer diagnosis. Tests of statistical significance were two-sided.RESULTS: The study included 19,867 male subjects and 21,748 female subjects. Fifty-three percent of the patients were white, 38% were black, and 5% were Hispanic. Of these, 1,149 developed lung cancer. After adjusting for known risk factors, patients residing in the most disadvantaged areas had a significantly increased incidence of lung cancer compared with those in the least disadvantaged areas (hazard ratio, 1.29; 95% CI 1.07-1.55).CONCLUSIONS: Census-derived estimates of neighborhood conditions have a powerful association with lung cancer incidence, even when adjusting for individual variables. Further research investigating the mechanisms that link neighborhood conditions to lung cancer is warranted.