Racial Segregation and Disparities in Breast Cancer Care and Mortality
Racial Segregation and Disparities in Breast Cancer Care and Mortality
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DOI：
10.1002/cncr.23828
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发表时间：
2008-10-15
期刊：
影响因子：
6.2
通讯作者：
Williams, David R.
中科院分区：
文献类型：
--
作者：
Haas, Jennifer S.;Earle, Craig C.;Williams, David R.
背景。关于居住隔离是否是乳腺癌治疗和乳腺癌死亡率的种族/民族差异的中介，或者种族/民族差异是否存在问题。来自监测、流行病学和最终结果-医疗保险数据库的数据对66 - 85岁的白人、黑人和西班牙裔乳腺癌妇女进行了检查，以确定她们是否接受了适当的乳腺癌治疗。黑人接受适当乳腺癌护理的可能性低于白人（优势比[OR]， 0.78； 95%可信区间[CI]， 0.71-0.86）。生活在黑人隔离更严重地区的黑人和白人都不太可能得到适当的乳腺癌护理（OR, 0.73; 95% CI, 0.64-0.82）。黑人隔离是黑人/白人在乳腺癌护理方面差异的中介，解释了8.9%的差异。调整后，西班牙裔与白人的适当护理没有显著差异，但居住在西班牙裔隔离程度较高地区的西班牙裔和白人接受适当乳腺癌护理的可能性较低（OR, 0.73; 95% CI, 0.61-0.89）。虽然黑人的乳腺癌死亡率高于白人，但黑人隔离并没有实质性地调节黑人-白人的生存差异，也没有显著与死亡率相关（危险比，1.03;95% CI, 0.87-1.21）。乳腺癌死亡率在西班牙裔和白人之间没有差异。在老年人中，种族隔离在一定程度上影响了乳腺癌治疗方面的黑人-白人差异，但对死亡率没有影响。居住在隔离程度较高的地区的人不太可能得到适当的乳腺癌护理。癌症2008;113:2166 - 72。(C) 2008年美国癌症协会。
BACKGROUND. Questions have existed as to whether residential segregation is a mediator of racial/ethnic disparities in breast cancer care and breast cancer mortality, or has a differential effect by race/ethnicity.METHODS. Data from the Surveillance, Epidemiology, and End Results-Medicare database on white, black, and Hispanic women aged 66 to 85 years with breast cancer were examined for the receipt of adequate breast cancer care.RESULTS. Blacks were less likely than whites to receive adequate breast cancer care (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.71-0.86). Individuals, both black and white, who lived in areas with greater black segregation were less likely to receive adequate breast cancer care (OR, 0.73; 95% CI, 0.64-0.82). Black segregation was a mediator of the black/white disparity in breast cancer care, explaining 8.9% of the difference. After adjustment, adequate care for Hispanics did not significantly differ from whites, but individuals, both Hispanic and white, who lived in areas with greater Hispanic segregation were less likely to receive adequate breast cancer care (OR, 0.73; 95% CI, 0.61-0.89). Although Blacks experienced greater breast cancer mortality than whites, black segregation did not substantially mediate the black-white disparity in survival, and was not significantly associated with mortality (hazards ratio, 1.03; 95% CI, 0.87-1.21). Breast cancer mortality did not differ between Hispanics and whites.CONCLUSIONS. Among seniors, segregation mediates some of the black-white disparity in breast cancer care, but not mortality. Individuals who live in more segregated areas are less likely to receive adequate breast cancer care. Cancer 2008; 113:2166-72. (C) 2008 American Cancer Society.