Adapting a model of cervical carcinogenesis to self-identified Black women to evaluate racial disparities in the United States.
Adapting a model of cervical carcinogenesis to self-identified Black women to evaluate racial disparities in the United States.
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将宫颈癌发生模型应用于自我认定的黑人女性，以评估美国的种族差异。
DOI：
10.1093/jncimonographs/lgad015
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Kim,JaneJ
中科院分区：
文献类型：
--
作者：
Spencer,JenniferC;Burger,EmilyA;Campos,NicoleG;Regan,MaryCaroline;Sy,Stephen;Kim,JaneJ
背景自认为美国黑人女性的宫颈癌发病率和死亡率高于一般人群，但这些差异尚未明确归因于所描述的癌症护理不平等。方法先前建立的宫颈癌微观模拟模型被改编以反映美国黑人女性的人口统计、筛查和生存数据，并与反映所有美国女性数据的模型进行比较。每个模型输入分层数据（全因死亡率，子宫切除率，筛查频率，筛查方式，随访和癌症生存率）依次替换为黑人种族特定数据，以达到反映黑人女性的完全指定模型。在每一步，我们估计的相对贡献的投入观察到的dispartial.ResultsEstimated（子宫切除术调整）宫颈癌的发病率为8.6每10万人在所有种族模型与10.8每10万人在黑人种族模型（相对风险[RR] = 1.24，范围= 1.23-1.27）。 估计所有种族的宫颈癌死亡率为2.9/10万，黑人模型为5.5/10万（RR = 1.92，范围= 1.85-2.00）。 我们发现，发病率差异的最大贡献者是积极筛查结果的随访（占总差异的47.3%）和筛查频率（32.7%）。对于死亡率的差异，最大的贡献者是癌症的生存差异（70.1%），其次是筛查随访（12.7%）。ConclusionTo减少宫颈癌发病率和死亡率的差异，重要的是要了解和解决整个护理的连续性的护理和质量的差异。专注于推动宫颈异常治疗和随访差异的实践和政策可能会产生最大的影响。
BackgroundSelf-identified Black women in the United States have higher cervical cancer incidence and mortality than the general population, but these differences have not been clearly attributed across described cancer care inequities.MethodsA previously established microsimulation model of cervical cancer was adapted to reflect demographic, screening, and survival data for Black US women and compared with a model reflecting data for all US women. Each model input with stratified data (all-cause mortality, hysterectomy rates, screening frequency, screening modality, follow-up, and cancer survival) was sequentially replaced with Black-race specific data to arrive at a fully specified model reflecting Black women. At each step, we estimated the relative contribution of inputs to observed disparities.ResultsEstimated (hysterectomy-adjusted) cervical cancer incidence was 8.6 per 100 000 in the all-race model vs 10.8 per 100 000 in the Black-race model (relative risk [RR] = 1.24, range = 1.23-1.27). Estimated all-race cervical cancer mortality was 2.9 per 100 000 vs 5.5 per 100 000 in the Black-race model (RR = 1.92, range = 1.85-2.00). We found the largest contributors of incidence disparities were follow-up from positive screening results (47.3% of the total disparity) and screening frequency (32.7%). For mortality disparities, the largest contributor was cancer survival differences (70.1%) followed by screening follow-up (12.7%).ConclusionTo reduce disparities in cervical cancer incidence and mortality, it is important to understand and address differences in care access and quality across the continuum of care. Focusing on the practices and policies that drive differences in treatment and follow-up from cervical abnormalities may have the highest impact.
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影响因子：
39.2
作者：
Kim JJ;Campos NG;Sy S;Burger EA;Cuzick J;Castle PE;Hunt WC;Waxman A;Wheeler CM;New Mexico HPV Pap Registry Steering Committee
通讯作者：
New Mexico HPV Pap Registry Steering Committee
影响因子：
3.5
作者：
Bespalov A;Barchuk A;Auvinen A;Nevalainen J
通讯作者：
Nevalainen J
结构性种族主义和乳腺癌特异性生存
影响因子：
9
作者：
N. Goel;A. Westrick;Zinzi Bailey;Alexandra E Hernandez;R. Balise;Erica Goldfinger;M. Antoni;Justin Stoler;S. Kesmodel;E. Kobetz
通讯作者：
E. Kobetz
影响因子：
4.7
作者：
Alimena, Stephanie;Yang, David D.;King, Martin
通讯作者：
King, Martin
影响因子：
254.7
作者：
Siegel, Rebecca L.;Miller, Kimberly D.;Jemal, Ahmedin
通讯作者：
Jemal, Ahmedin