Racial/Ethnic and Socioeconomic Differences in Short-Term Breast Cancer Survival Among Women in an Integrated Health System
Racial/Ethnic and Socioeconomic Differences in Short-Term Breast Cancer Survival Among Women in an Integrated Health System
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DOI：
10.2105/ajph.2014.302406
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发表时间：
2015-05-01
影响因子：
12.7
通讯作者：
Gomez, Scarlett L.
中科院分区：
文献类型：
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作者：
Keegan, Theresa H. M.;Kurian, Allison W.;Gomez, Scarlett L.
目标。我们研究了种族/族裔和社区社会经济地位 (SES) 对统一获得医疗保健和治疗的妇女短期生存的综合影响。方法。使用北加州 Kaiser Permanente 的电子病历数据与加州癌症登记处的数据相结合，我们纳入了 6262 名新诊断患有浸润性乳腺癌的女性。我们使用多变量 Cox 比例风险回归分析了生存率，并进行了 2010 年的随访。结果。考虑到肿瘤分期、亚型、合并症和接受的治疗类型后，生活在低 SES 社区的非西班牙裔白人女性（风险比 [HR] = 1.28；95% 置信区间 [CI] = 1.07, 1.52）和非裔美国人，无论社区 SES 为何（高 SES：HR= 1.44；95% CI = 1.01, 2.07；低 SES： HR= 1.88；95% CI = 1.42, 2.50) 的总体生存率比生活在高 SES 社区的非西班牙裔白人女性更差。乳腺癌特异性生存率的结果相似，但生活在高社会经济地位社区的非裔美国人和非西班牙裔白人的生存率相似。结论。解决可能影响治疗强度和依从性的潜在因素（例如合并症和后勤障碍）的策略应针对社会经济地位低的非西班牙裔白人和所有非裔美国患者。
Objectives. We examined the combined influence of race/ethnicity and neighborhood socioeconomic status (SES) on short-term survival among women with uniform access to health care and treatment.Methods. Using electronic medical records data from Kaiser Permanente Northern California linked to data from the California Cancer Registry, we included 6262 women newly diagnosed with invasive breast cancer. We analyzed survival using multivariable Cox proportional hazards regression with follow-up through 2010.Results. After consideration of tumor stage, subtype, comorbidity, and type of treatment received, non-Hispanic White women living in low-SES neighborhoods (hazard ratio [HR] = 1.28; 95% confidence interval [CI] = 1.07, 1.52) and African Americans regardless of neighborhood SES (high SES: HR= 1.44; 95% CI = 1.01, 2.07; low SES: HR= 1.88; 95% CI = 1.42, 2.50) had worse overall survival than did non-Hispanic White women living in high-SES neighborhoods. Results were similar for breast cancer-specific survival, except that African Americans and non-Hispanic Whites living in high-SES neighborhoods had similar survival.Conclusions. Strategies to address the underlying factors that may influence treatment intensity and adherence, such as comorbidities and logistical barriers, should be targeted at low-SES non-Hispanic White and all African American patients.