Disparities in survival after female breast cancer diagnosis: a population-based study
Disparities in survival after female breast cancer diagnosis: a population-based study
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DOI：
10.1007/s10552-013-0246-5
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发表时间：
2013-09-01
影响因子：
2.3
通讯作者：
Byrne, Margaret M.
中科院分区：
文献类型：
--
作者：
Tannenbaum, Stacey L.;Koru-Sengul, Tulay;Byrne, Margaret M.
尽管在治疗和增加筛查方面取得了进展，但女性乳腺癌生存率仍受种族，民族和社会经济地位（SES）的影响。本研究的目的是在一个大型且独特的数据集中证实乳腺癌死亡率的差异，该数据集包含7个不同的种族群体、31种合并症、人口统计学和临床/病理学患者特征以及社区贫困信息。（1996-2007）与美国卫生保健管理局和美国人口普查区（n = 127，754）相关，通过Kaplan-Meier方法探索中位生存率和1年、3年和5年生存率。对数秩检验比较了不同人种/种族/SES的生存曲线。考克斯比例风险回归模型用于获得未校正和校正的风险比（HR）和95%置信区间。美洲原住民的中位生存期最低（7. 4年），亚洲人最高（12. 6年）。对于单变量分析，黑人的生存率更差（HR = 1.44; p < 0.001），亚洲人（HR = 0.71; p < 0.001），亚洲印度人或巴基斯坦人（HR = 0.65; p = 0.013）和西班牙裔人（HR = 0.92; p < 0.001）的生存率更好。多变量分析显示黑人的持续生存损害（HR = 1.28; p < 0.001）和西班牙裔的改善生存（HR = 0.90; p = 0.001）。对于SES，在所有分析中，SES类别越高，生存率越高（p < 0.001）。我们利用一个大型的富集状态癌症登记系统，控制了多种人口统计学、临床和合并症，充分探讨了女性乳腺癌的生存差异，发现种族、民族和SES的某些方面与乳腺癌生存率显著相关。需要更多的研究来揭示这些持续差异的根源。
Despite advances in treatment and increased screening, female breast cancer survival is affected by race, ethnicity, and socioeconomic status (SES). The purpose of this study was to substantiate disparities in breast cancer mortality in a large and unique dataset containing 7 distinct racial groups, 31 comorbidities, demographic and clinical/pathological patient characteristics, and neighborhood poverty information.Florida Cancer Data System registry (1996-2007) linked with the Agency for Health Care Administration and U.S. Census tract (n = 127,754) explored median survival and 1-, 3-, and 5-year survival rates by the Kaplan-Meier method. Log-rank tests compared survival curves by race/ethnicity/SES. Cox proportional hazards regression models were used to obtain unadjusted and adjusted hazard ratios (HR) and 95 % confidence intervals.Native Americans had the lowest median survival (7.4 years) and Asians had the highest (12.6 years). For the univariate analysis, worse survival was seen for blacks (HR = 1.44; p < 0.001) and better survival for Asians (HR = 0.71; p < 0.001), Asian Indians or Pakistanis (HR = 0.65; p = 0.013), and Hispanics (HR = 0.92; p < 0.001). Multivariate analysis demonstrated sustained survival detriment for blacks (HR = 1.28; p < 0.001) and improved survival for Hispanics (HR = 0.90; p = 0.001). For SES, there was an incremental improvement in survival for each higher SES category in all analyses (p < 0.001).Utilizing a large enriched state cancer registry controlling for multiple demographic, clinical, and comorbidities, we fully explored survival disparities in female breast cancer and found certain aspects of race, ethnicity, and SES to remain significantly associated with breast cancer survival. More research is needed to uncover the source of these ongoing disparities.