Racialized Economic Segregation and Breast Cancer Mortality among Women in Maryland.
Racialized Economic Segregation and Breast Cancer Mortality among Women in Maryland.
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DOI：
10.1158/1055-9965.epi-21-0923
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发表时间：
2022-03
期刊：
影响因子：
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通讯作者：
Hayes JH
中科院分区：
文献类型：
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作者：
Connor AE;Kaur M;Dibble KE;Visvanathan K;Dean LT;Hayes JH
我们的目标是确定种族化的经济隔离和马里兰州乳腺癌（BC）死亡率之间的关系。在2007-2017年期间，在马里兰州诊断为偶发性侵入性BC的35，066名妇女（24，540名白色; 10，526名黑人）中，使用极端集中指数指标在人口普查区水平测量了种族化经济隔离的暴露情况。使用考克斯比例风险回归估计种族化经济隔离与BC死亡率风险之间的关联的风险比（HR）和95%置信区间（CI），解释人口普查区水平的聚类。模型根据年龄进行调整，并根据种族、中位年龄（<60岁，≥60岁）和临床特征进行分层。总体而言，与最优越的五分之一人口相比，种族化经济隔离的最不优越的五分之一人口的BC死亡率风险高1.84倍（95% CI：1.64，2.06）。这种关联显著不同（p-相互作用< 0.05），按种族和年龄，1.20（95% CI：0.90，1.60）是黑人女性BC死亡率风险的1.66倍（95%CI：1.41，1.95）是白色女性危险的两倍，对年轻女性的危险更大（HR：2.17，95% CI：1.83，2.57）比老年妇女（HR：1.62，95% CI：1.40，1.88）。我们的研究结果表明，不列颠哥伦比亚省的生存差距存在于马里兰州的妇女居住在最特权的人口普查区与低收入家庭和较高比例的黑人居民。我们的研究结果为马里兰州妇女中观察到的BC死亡率差异提供了新的见解。
Our objective was to determine the association between racialized economic segregation and the hazard of breast cancer (BC) mortality in Maryland. Among 35,066 women (24,540 White; 10,526 Black) diagnosed with incident invasive BC in Maryland during 2007–2017, exposure to racialized economic segregation was measured at the census tract level using Index of Concentration at the Extremes metrics. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional hazards regression for the association between racialized economic segregation and the hazard of BC mortality, accounting for clustering at the census tract level. Models were adjusted for age and stratified by race, median age (<60 years, ≥60 years), and clinical characteristics. Overall, the hazard of BC mortality was 1.84 times as high (95% CI: 1.64, 2.06) for the least privileged quintile of racialized economic segregation compared to the most privileged quintile. This association differed significantly (p-interaction< 0.05) by race and age, with 1.20 (95% CI: 0.90, 1.60) times the hazard of BC mortality for Black women versus 1.66 (95% CI: 1.41, 1.95) times the hazard for White women, and with greater hazards for younger women (HR: 2.17, 95% CI: 1.83, 2.57) than older women (HR: 1.62, 95% CI: 1.40, 1.88). Our results suggest that BC survival disparities exist in Maryland among women residing in the least privileged census tracts with lower income households and higher proportions of Black residents. Our findings provide new insights into the BC mortality disparities observed among women in Maryland.