The association of area-level social class and tobacco use with adverse breast cancer characteristics among white and black women: evidence from Maryland, 1992-2003
The association of area-level social class and tobacco use with adverse breast cancer characteristics among white and black women: evidence from Maryland, 1992-2003
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DOI：
10.1186/s12942-015-0007-7
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发表时间：
2015-04-01
影响因子：
4.9
通讯作者：
Curriero, Frank C.
中科院分区：
文献类型：
--
作者：
Klassen, Ann C.;Pankiewicz, Aaron;Curriero, Frank C.
背景：在乳腺癌中，较差的疾病特征与较少的社会资源和黑人有关。然而，尚不清楚社会梯度是否在种族间有类似的影响，以及包括吸烟在内的行为是否可以解释部分社会梯度。方法：我们建立了区域社会阶层、烟草消费和肿瘤特征之间的关系模型，使用了美国东海岸种族和经济多样化的马里兰州1992-2003年诊断的50,062例白人和黑人病例。多层次模型估计了地区层面的社会阶层和烟草消费对肿瘤分级、大小和诊断阶段的影响。结果：调整种族、年龄和诊断年份后，较高的社会阶层与组织学分级为3级或4级的肿瘤（O.R. 0.96, 95% C.I. 0.94,0.99）、诊断为SEER 2期或更晚（O.R. 0.89, 95% C.I. 0.86, 0.91）和肿瘤大小为bbb2cm （O.R. 0.87, 95% C.I. 0.84, 0.90）的风险较低相关。较高的烟草消费与更高级别肿瘤（O.R. 1.01, 1.00, 1.03）和更大肿瘤（O.R. 1.03, 95% C.I. 1.01, 1.06）的风险相关，但与晚期肿瘤（O.R. 1.00, 95% C.I. 0.98, 1.02）的风险相关无统计学意义。社会阶层对黑人女性的保护作用较弱，但烟草的影响并不是种族特异性的。结论：结果表明，在美国的一个地理区域，黑人和白人妇女受到不同社会阶层的不同保护，支持在乳腺癌差异调查中使用交叉性理论。区域水平的烟草消费可能包括病例的直接使用和二手烟暴露，但也可能确定超出社会阶层衡量的与癌症相关的过度行为或环境暴露的社区。鉴于烟草成瘾和侵袭性乳腺癌的全球负担日益加重，有必要在不同的地理区域进行类似的调查。
Background: In breast cancer, worse disease characteristics are associated with fewer social resources and black race. However, it is unknown whether social gradients have similar impact across race, and whether behaviors, including tobacco use, may explain a portion of the social gradient.Methods: We modeled relationships between area-level social class, tobacco spending and tumor characteristics, using 50,062 white and black cases diagnosed from 1992-2003 in Maryland, a racially and economically diverse state on the east coast of the United States. Multi-level models estimated the effect of area-level social class and tobacco consumption on tumor grade, size, and stage at diagnosis.Results: Adjusting for race, age and year of diagnosis, higher social class was associated with lower risk for tumors with histological grade 3 or 4 (O.R. 0.96, 95% C.I. 0.94,0.99), those diagnosed at SEER stage 2 or later (O.R. 0.89, 95% C.I. 0.86, 0.91), and tumor size > 2 cm (O.R. 0.87, 95% C.I. 0.84, 0.90). Higher tobacco spending was associated with higher risk for higher grade (O.R. 1.01, 1.00, 1.03) and larger tumors (O.R. 1.03, 95% C.I. 1.01, 1.06), but was not statistically significantly related to later stage (O.R. 1.00, 95% C.I. 0.98, 1.02). Social class was less protective for black women, but tobacco effects were not race-specific.Conclusions: Results suggest that in one U.S. geographic area, there is a differential protection from social class for black and white women, supporting use of intersectionality theory in breast cancer disparities investigations. Area-level tobacco consumption may capture cases' direct use and second hand smoke exposure, but also may identify neighborhoods with excess cancer-related behavioral or environmental exposures, beyond those measured by social class. Given the growing global burden of both tobacco addiction and aggressive breast cancer, similar investigations across diverse geographic areas are warranted.