The Effects of Residential Segregation and Neighborhood Characteristics on Surgery and Survival in Patients with Early-Stage Non-Small Cell Lung Cancer
The Effects of Residential Segregation and Neighborhood Characteristics on Surgery and Survival in Patients with Early-Stage Non-Small Cell Lung Cancer
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DOI：
10.1158/1055-9965.epi-15-1126
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发表时间：
2016-05-01
影响因子：
3.8
通讯作者：
Bayakly, Rana
中科院分区：
文献类型：
--
作者：
Johnson, Asal M.;Johnson, Allen;Bayakly, Rana
背景：虽然较低的社会经济地位对非小细胞肺癌 (NSCLC) 治疗和生存的负面影响已得到广泛研究，但居住隔离对预后和接受治疗的影响尚未确定。 方法：这是一项针对佐治亚州 NSCLC 患者（2000-2009 年；n = 8,322）的回顾性队列研究，使用了佐治亚州综合癌症登记处的数据。在单独的多水平模型中研究了隔离、经济剥夺和组合隔离/剥夺对接受手术几率的影响。为了确定感兴趣的暴露与不同种族群体死亡风险之间的关联，对黑人和白人患者进行了单独的多水平生存模型。结果：居住在隔离水平最高[AOR = 0.35，95% CI，0.19-0.64]和第二高（AOR = 0.37，95% CI，0.20-0.68）的地区与接受隔离的几率降低相关。手术。即使在手术得到控制后，居住在居住隔离程度高和经济贫困程度高的地区的黑人患者死亡的可能性也高出 31%（95% CI，1.04-1.66）。对于白人患者来说，经济匮乏与手术几率降低有关，但与生存率无关。种族隔离没有影响。结论：我们的研究结果表明，黑人和白人经历种族隔离和地区贫困的方式可能不同，从而导致不良健康结果的差异。影响：确定影响不同种族群体内健康结果的社区特征可以通过实施有针对性的政策和干预措施来帮助减少种族群体之间的健康差异。 (C) 2016 年 AACR。
Background: Although the negative effects of lower socioeconomic status on non-small cell lung cancer (NSCLC) treatment and survival have been widely studied, the impact of residential segregation on prognosis and the receipt of treatment has yet to be determined.Methods: This is a retrospective, cohort study of NSCLC patients in Georgia (2000-2009; n = 8,322) using data from the Georgia Comprehensive Cancer Registry. The effects of segregation, economic deprivation, and combined segregation/deprivation on the odds of receiving surgery were examined in separate multilevel models. To determine the association for the exposures of interest on the risk of death for different racial groups, separate multilevel survival models were conducted for black and white patients.Results: Living in areas with the highest [AOR = 0.35, 95% confidence interval (CI), 0.19-0.64] and second highest (AOR = 0.37, 95% CI, 0.20-0.68) levels of segregation was associated with decreased odds of receipt of surgery. Black patients living in areas with high residential segregation and high economic deprivation were 31% (95% CI, 1.04-1.66) more likely to die, even after surgery was controlled for. For white patients, economic deprivation was associated with decreased odds of surgery but not survival. Segregation had no effect.Conclusion: Our findings suggest how black and white individuals experience segregation and area-level poverty is likely different leading to differences in adverse health outcomes.Impact: Identifying neighborhood characteristics impacting health outcomes within different racial groups could help reduce health disparities across racial groups by implementing targeted policies and interventions. (C) 2016 AACR.