Spatial association of racial/ethnic disparities between late-stage diagnosis and mortality for female breast cancer: where to intervene?
Spatial association of racial/ethnic disparities between late-stage diagnosis and mortality for female breast cancer: where to intervene?
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DOI：
10.1186/1476-072x-10-24
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发表时间：
2011-04-04
影响因子：
4.9
通讯作者：
Zhan FB
中科院分区：
文献类型：
--
作者：
Tian N;Wilson JG;Zhan FB
在过去的二十年中，由于不同种族/族裔群体获得的医疗福利不成比例，晚期诊断和死亡率结果之间的种族/族裔差异扩大了。到目前为止，很少有研究探讨了乳腺癌晚期诊断和死亡率之间的种族/民族差异的空间关系，以及社会经济地位（SES）对这两个差异的影响，在更精细的地理尺度。采用三种方法评估乳腺癌晚期诊断和死亡率的种族/民族差异之间的空间关系。首先，本研究使用率差测量来测试1995-2005年德克萨斯州女性乳腺癌晚期诊断和死亡率的种族/民族差异。其次，我们使用线性和逻辑回归模型来确定这两个种族/民族差异之间是否存在相关性。第三，进行地理加权回归分析，以评估在对当地邻居加权后是否存在这种相关性。发现晚期诊断和乳腺癌死亡率之间种族差异的空间关联显著，非洲裔美国人的优势比为33.76（CI：23.96-47.57），西班牙裔为30.39（CI：22.09-41.82）。在调整SES共同创始人后，logistic回归模型显示，非洲裔美国妇女的优势比为18.39（CI：12.79-26.44），西班牙裔妇女的优势比为11.64（CI：8.29-16.34），尽管仍然非常显著。逻辑回归分析结果表明，低和中等社会经济地位的人口普查区更有可能在乳腺癌晚期诊断和死亡率方面表现出显着的种族差异。然而，当地的相关系数值表明，这两种类型的种族/民族差异的协会不同的地理区域。这项研究可能具有健康政策的意义，可以通过在目标地区实施有效的干预计划，帮助弱势少数群体早期发现乳腺癌。
Over the past twenty years, racial/ethnic disparities between late-stage diagnoses and mortality outcomes have widened due to disproportionate medical benefits that different racial/ethnic groups have received. Few studies to date have examined the spatial relationships of racial/ethnic disparities between breast cancer late-stage diagnosis and mortality as well as the impact of socioeconomic status (SES) on these two disparities at finer geographic scales. Three methods were implemented to assess the spatial relationship between racial/ethnic disparities of breast cancer late-stage diagnosis and morality. First, this study used rate difference measure to test for racial/ethnic disparities in both late-stage diagnosis and mortality of female breast cancer in Texas during 1995-2005. Second, we used linear and logistic regression models to determine if there was a correlation between these two racial/ethnic disparities at the census tract level. Third, a geographically-weighted regression analysis was performed to evaluate if this correlation occurred after weighting for local neighbors. The spatial association of racial disparities was found to be significant between late-stage diagnosis and breast cancer mortality with odds ratios of 33.76 (CI: 23.96-47.57) for African Americans and 30.39 (CI: 22.09-41.82) for Hispanics. After adjusting for a SES cofounder, logistic regression models revealed a reduced, although still highly significant, odds ratio of 18.39 (CI: 12.79-26.44) for African-American women and 11.64 (CI: 8.29-16.34) for Hispanic women. Results of the logistic regression analysis indicated that census tracts with low and middle SES were more likely to show significant racial disparities of breast cancer late-stage diagnosis and mortality rates. However, values of local correlation coefficients suggested that the association of these two types of racial/ethnic disparities varied across geographic regions. This study may have health-policy implications that can help early detection of breast cancer among disadvantaged minority groups through implementing effective intervention programs in targeted regions.