Racial disparities in treatment and survival of women with stage I-III breast cancer at a large academic medical center in metropolitan Detroit
Racial disparities in treatment and survival of women with stage I-III breast cancer at a large academic medical center in metropolitan Detroit
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DOI：
10.1007/s10549-005-0324-9
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发表时间：
2005-06-01
影响因子：
3.8
通讯作者：
Simon, MS
中科院分区：
文献类型：
--
作者：
Du, W;Simon, MS
非裔美国妇女患乳腺癌的死亡率高于白人妇女，一些研究表明，这种差异可能部分归因于获得医疗保健的机会不平等。本研究的目的是分析在一个大型学术医疗中心治疗浸润性乳腺癌的妇女在模式和护理费用和生存方面的种族差异。研究对象包括331名AA和257名在1994年至1997年间被诊断为I-III期乳腺癌的白人妇女。临床、社会人口学和成本数据来自医疗记录、癌症登记和医院财务数据库。收集了诊断后1年内使用癌症定向治疗（手术、放疗、化疗和激素治疗）的数据。生存分析通过调整年龄、分期、淋巴结受累、ER/PR状态以及高血压、糖尿病、心脏病和脑血管意外的诊断来比较无病和总生存率。在治疗的使用和费用方面没有显著的种族差异。平均总1年治疗费用为aa患者16,348美元，高加索患者15,120美元。虽然AAs的未调整相对危险度（RR）为2.09 （95% CI: 1.41-3.10）和1.56 (95% CI: 1.09-2.25)，但多因素调整分析显示复发率（1.38）（95% CI: 0.85-2.26）和死亡率（1.06）（95% CI: 0.64-1.75）无显著差异。在治疗和费用方面没有明显的种族差异。我们的研究结果支持这样一个理论，即平等的治疗产生平等的结果。筛查的改进可能对少数民族乳腺癌妇女的生存有重要影响。
African-American (AA) women with breast cancer have higher mortality rates than Caucasian woman, and some studies have suggested that this disparity may be partly explained by unequal access to medical care. The purpose of this study was to analyze racial differences in patterns and costs of care and survival among women treated for invasive breast cancer at a large academic medical center. Subjects included 331 AA and 257 Caucasian women diagnosed with stage I-III breast cancer between 1994 and 1997. Clinical, socio-demographic, and cost data were obtained from the medical record, cancer registry, and hospital financial database. Data were collected on the use of cancer directed treatments (surgery, radiation, chemo and hormonal therapy) up to 1-year post-diagnosis. Survival analyses compared disease-free and overall survival by race adjusting for age, stage, nodal involvement, ER/PR status and a diagnosis of hypertension, diabetes, heart disease and cerebral vascular accident. There were no significant racial differences in treatment utilization and costs. The mean total 1-year treatment costs were $16,348 for AAs and $15,120 for Caucasians. While AAs had a significantly higher unadjusted relative risk (RR) of recurrence 2.09 (95% CI: 1.41-3.10) and death 1.56 (95% CI: 1.09-2.25), the multivariate adjusted analyses resulted in no significant differences in recurrence 1.38 (95% CI: 0.85-2.26) or death 1.06 (95% CI: 0.64-1.75). There was no obvious racial disparity in treatment and costs noted. Our findings support the theory that equal treatments produce equal outcomes. Improvement in screening may have an important impact on survival among minority women with breast cancer.