Racial Differences in Time to Breast Cancer Surgery and Overall Survival in the US Military Health System
Racial Differences in Time to Breast Cancer Surgery and Overall Survival in the US Military Health System
复制标题
DOI：
10.1001/jamasurg.2018.5113
复制
发表时间：
2019-03-01
期刊：
影响因子：
16.9
通讯作者：
Zhu, Kangmin
中科院分区：
文献类型：
--
作者：
Eaglehouse, Yvonne L.;Georg, Matthew W.;Zhu, Kangmin
乳腺癌诊断后手术时间（TTS）的种族差异以及这些差异是否解释了美国人群总体生存率的差异尚未得到充分研究。目的比较非西班牙裔黑人（NHB）和非西班牙裔白人（NHW）乳腺癌妇女的TTS，并研究TTS的种族差异是否可以解释全民医疗保健系统中总生存率的种族差异。设计、环境和参与者：从美国国防部中央癌症登记处和军事卫生系统数据存储库链接数据库中确定的回顾性队列，该数据库包含1998年1月1日至2008年12月31日期间在美国军事卫生系统中诊断为I至III期乳腺癌并接受保乳手术（BCS）或乳房切除术的998名NHB妇女和3899名NHW妇女的记录。数据分析时间为2017年7月5日至2017年12月29日。主要结局和测量主要结局为乳腺癌手术时间。采用多变量分位数回归，比较非西班牙裔黑人和非西班牙裔妇女TTS的第25、第50（中位数）、第75和第90百分位。采用Cox比例风险回归模型，在先不加TTS后再加TTS控制潜在混杂因素后，估计NHB与NHW女性全因死亡的风险比（hr）和95% ci。结果4887例NHB和NHW女性中，平均（SD）年龄为50.0（9.4）岁。NHW女性的中位TTS为21天（95% CI, 20.6-21.4天），NHB女性的中位TTS为22天（95% CI, 20.6-23.4天）。在多变量模型中，非西班牙裔黑人妇女在第75（3.6天，95% CI, 1.6-5.5天）和第90（8.9天，95% CI, 5.1-12.6天）的TTS估计显著高于非西班牙裔黑人妇女。不同手术类型的估计差异相似。在接受保乳手术的患者中，非西班牙裔黑人妇女的调整后死亡风险（HR, 1.45; 95% CI, 1.06-2.01）高于非西班牙裔黑人妇女。在接受乳房切除术的患者中，不同种族之间的风险相似（HR, 1.06; 95% CI, 0.76-1.48）。在Cox比例风险回归模型中加入TTS后，hr保持相似。结论和相关性本研究结果表明，在军队卫生系统中，与非裔美国人相比，非裔美国人的乳腺癌手术时间延迟。然而，TTS的种族差异并不能解释在接受保乳手术的妇女中观察到的总体生存率的种族差异。
IMPORTANCE Racial disparities in time to surgery (TTS) after a breast cancer diagnosis and whether these differences account for disparities in overall survival have been understudied in the US population.OBJECTIVES To compare TTS in non-Hispanic black (NHB) and non-Hispanic white (NHW) women with breast cancer and to examine whether racial differences in TTS may explain possible racial disparities in overall survival in a universal health care system.DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort identified from the Department of Defense Central Cancer Registry and Military Health System Data Repository linked databases containing records between January 1, 1998, and December 31, 2008, of 998 NHB women and 3899 NHW women who received a diagnosis of stages I to III breast cancer and underwent breast-conserving surgery (BCS) or mastectomy in the US Military Health System during the study period. Data analyses were conducted from July 5, 2017, to December 29, 2017.MAIN OUTCOMES AND MEASURES The main outcome was time to breast cancer surgery. Non-Hispanic black and NHW women were compared at the 25th, 50th (median), 75th, and 90th percentiles of TTS by using multivariable quantile regression. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs for all-cause death in NHB compared with NHW women after controlling for potential confounders first without and then with TTS.RESULTS Among the 4887 NHB and NHW women in the cohort, the mean (SD) age was 50.0 (9.4) years. The median TTS was 21 days (95% CI, 20.6-21.4 days) among NHW women and 22 days (95% CI, 20.6-23.4 days) among NHB women. Non-Hispanic black women had a significantly greater estimated TTS at the 75th (3.6 days; 95% CI, 1.6-5.5 days) and 90th (8.9 days; 95% CI, 5.1-12.6 days) percentiles than NHW women in multivariable models. The estimated differences were similar by surgery type. Non-Hispanic black women had a higher adjusted risk for death (HR, 1.45; 95% CI, 1.06-2.01) compared with NHW women among patients receiving breast-conserving surgery. The risks were similar between races among those receiving mastectomy (HR, 1.06; 95% CI, 0.76-1.48). The HRs remained similar after adding TTS to the Cox proportional hazards regression models.CONCLUSIONS AND RELEVANCE This study's results indicate that time to breast cancer surgery was delayed for NHB compared with NHW women in the Military Health System. However, the racial differences in TTS did not explain the observed racial differences in overall survival among women who received breast-conserving surgery.