Race, socioeconomic status, and breast cancer treatment and survival.
Race, socioeconomic status, and breast cancer treatment and survival.
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DOI：
10.1093/jnci/94.7.490
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发表时间：
2002-04
期刊：
影响因子：
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通讯作者：
C. Bradley;C. Given;Caralee Roberts
中科院分区：
文献类型：
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作者：
C. Bradley;C. Given;Caralee Roberts
背景以前的研究发现，非洲裔美国妇女比白色妇女更有可能在诊断时患晚期乳腺癌，并缩短生存期。然而，关于这些诊断和生存率的差异是否归因于种族或社会经济地位存在相当大的争议。我们的目标是理清种族和社会经济地位对乳腺癌分期、治疗和生存的影响。我们将来自底特律大都会监测、流行病学和最终结果（SEER）（1）登记处的数据与密歇根州医疗补助计划的登记文件相关联，并确定了5719名诊断为乳腺癌的妇女，其中593人由医疗补助计划投保。我们首先计算了与种族、医疗补助保险和贫困相关的未经调整的比值比（OR），这些比值比与诊断时的乳腺癌分期、乳腺癌治疗和死亡有关。在控制了临床和非临床因素后，我们使用逻辑回归法估计了诊断时患有晚期乳腺癌、保乳手术、不手术和死亡的OR。所有统计检验均为双侧检验。结果在控制医疗补助登记和贫困之前，非洲裔美国妇女比白色妇女有更高的可能性，每一个不利的乳腺癌结果。然而，在控制了协变量后，非裔美国妇女与白色妇女在大多数结局上没有统计学显著差异，除了手术选择。非裔美国女性比白色女性更可能不接受手术（调整后OR = 1.62; 95%置信区间[CI] = 1.11 - 2.37）。在接受手术的女性中，非裔美国女性比白色女性更有可能接受保乳手术（调整后OR = 1.63; 95% CI = 1.33 - 1.98）。结论：与过去的研究相比，医疗补助和SEER数据的联系提供了关于低收入妇女的更深入的信息。在我们的底特律大都会研究人群中，种族与不利的乳腺癌结局无统计学显著相关性。然而，低社会经济地位与诊断时的晚期乳腺癌、接受的治疗类型和死亡相关。
BACKGROUND Previous studies have found that African-American women are more likely than white women to have late-stage breast cancer at diagnosis and shortened survival. However, there is considerable controversy as to whether these differences in diagnosis and survival are attributable to race or socioeconomic status. Our goal was to disentangle the influence of race and socioeconomic status on breast cancer stage, treatment, and survival. METHODS We linked data from the Metropolitan Detroit Surveillance, Epidemiology, and End Results (SEER)(1) registry to Michigan Medicaid enrollment files and identified 5719 women diagnosed with breast cancer, of whom 593 were insured by Medicaid. We first calculated the unadjusted odds ratios (ORs) associated with race, Medicaid insurance, and poverty for breast cancer stage at diagnosis, breast cancer treatment, and death. We then estimated the ORs of having late-stage breast cancer at diagnosis, breast-conserving surgery, no surgery, and death using logistic regression after controlling for clinical and nonclinical factors. All statistical tests were two-sided. RESULTS Before controlling for Medicaid enrollment and poverty, African-American women had a higher likelihood than white women of each unfavorable breast cancer outcome. However, after controlling for covariates, African-American women were not statistically significantly different from white women on most outcomes except for surgical choice. African-American women were more likely than white women to have no surgery (adjusted OR = 1.62; 95% confidence interval [CI] = 1.11 to 2.37). Among women who had surgery, African-American women were more likely to have breast-conserving surgery than were white women (adjusted OR = 1.63; 95% CI = 1.33 to 1.98). CONCLUSIONS The linkage of Medicaid and SEER data provides more in-depth information on low-income women than has been available in past studies. In our Metropolitan Detroit study population, race was not statistically significantly associated with unfavorable breast cancer outcomes. However, low socioeconomic status was associated with late-stage breast cancer at diagnosis, type of treatment received, and death.