Disparities in breast cancer prognostic factors by race, insurance status, and education
Disparities in breast cancer prognostic factors by race, insurance status, and education
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DOI：
10.1007/s10552-010-9572-z
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发表时间：
2010-09-01
影响因子：
2.3
通讯作者：
Ward, Elizabeth
中科院分区：
文献类型：
--
作者：
DeSantis, Carol;Jemal, Ahmedin;Ward, Elizabeth
黑人女性比白人女性更有可能被诊断为晚期乳腺癌和其他不太有利的乳腺癌预后因素。这项研究的目的是检验社会经济地位的标记物在多大程度上解释了这些因素中的黑人和白人的差异。我们的研究包括美国国家癌症数据库中2004-2005年间被诊断为浸润性乳腺癌的193,969名女性，约占美国所有接受治疗的癌症患者的72%。与白人女性相比，黑人女性更容易被诊断为分化较差(OR=2.55，95%可信区间(CI)2.44-2.66)、激素受体阴性(OR=2.29，95%CI 2.22-2.37)、大(OR=1.87，95%CI 1.80-1.95)、转移(OR=1.89，95%CI 1.78-2.00)和淋巴结阳性(OR=1.44，95%可信区间1.40-1.48)。在多变量分析中，保险和地区教育程度的调整可以解释31-39%的肿瘤大小和转移的差异，但只有大约14%的级别和激素受体的差异。在考虑种族和其他协变量后，没有保险的女性发生转移的可能性是私人保险女性的3.66倍(95%可信区间3.30-4.07)，患大肿瘤的可能性是私人保险女性的2.37倍(95%可信区间2.17-2.58)。同样，随着地区教育程度的降低，预后因素较差的乳腺癌的风险也会增加。将医疗保险覆盖范围扩大到所有妇女，可能会对减少预后因素较差的乳腺癌的发展中的种族差异产生影响。
Black women are more likely to be diagnosed with advanced stage and other less favorable breast cancer prognostic factors than white women. The aim of this study was to examine the extent to which markers of socioeconomic position accounts for black-white differences in these factors. Our study included 193,969 women diagnosed with invasive breast cancers during 2004-2005 from the National Cancer Database, which represents about 72% of all patients with cancer treated in the United States. Compared to white women, black women are more likely to be diagnosed with breast tumors that are less differentiated (odds ratio (OR) = 2.55, 95% confidence interval (CI) 2.44-2.66), hormone receptor negative (OR = 2.29, 95% CI 2.22-2.37), large (OR = 1.87, 95% CI 1.80-1.95), metastatic (OR = 1.89, 95% CI 1.78-2.00), and lymph node-positive (OR = 1.44, 95% CI 1.40-1.48). In multi-variable analyses, adjustment for insurance and area-level educational attainment explained 31-39% of the differences in tumor size and metastasis, but only about 14% of the differences in grade and hormone receptors. After accounting for race and other covariates, uninsured women remained 3.66 (95% CI 3.30-4.07) times more likely to have metastasis and 2.37 (95% CI 2.17-2.58) times more likely to have large tumors compared to privately insured women. Similarly, the risk of having breast cancer with less favorable prognostic factors increased as area-level educational attainment decreased. Extending health insurance coverage to all women is likely to have an effect on reducing racial disparities in the development of breast cancers with poor prognostic factors.