The impact of socioeconomic status and race on trial participation for older women with breast cancer
The impact of socioeconomic status and race on trial participation for older women with breast cancer
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DOI：
10.1002/cncr.20792
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发表时间：
2005-02-01
期刊：
影响因子：
6.2
通讯作者：
Krumholz, HM
中科院分区：
文献类型：
--
作者：
Gross, CP;Filardo, G;Krumholz, HM
背景资料。老年妇女，特别是老年少数民族，在乳腺癌试验中的代表性不足。虽然社会经济地位(SES)与种族和年龄有关，但据作者所知，关于SES对老年乳腺癌女性试验登记的影响知之甚少。方法：作者进行了一项病例对照研究，比较了参加国家癌症研究所合作小组乳腺癌试验(CASES)的妇女与从关联监测、流行病学和最终结果(SEER)医疗保险数据库获得的基于人群的乳腺癌患者样本(对照)。样本仅限于居住在SEER地区的年龄大于或等于65岁的妇女。社会保障服务的指标包括低于贫困线(按邮政编码)和失业(按县)的人口比例，以及有医疗补助保险覆盖的人口比例。结果：在双变量分析中，试验参与者居住在高贫困邮政编码地区(分别为20.9%比24.9%；P<；0.001)或拥有医疗补助保险(2.0%比10.0%0；P<；0.0001)的可能性显著低于社区癌症患者。在调整种族、年龄和县后，参加试验仍然与居住在高贫困地区(OR与剩余县居民的优势比[OR]为0.78；95%可信区间[95%CI]，0.62-0.98)、高失业率(OR与最低四分位数县居民的OR，0.50；95%CI，0.35-0.71)以及是否拥有医疗补助保险(OR与没有医疗补助的女性，0.22；95%CI，0.13-0.37)呈负相关；未发现黑人种族与试验参与度有关(黑人与白人的OR为1.0；95%的可信区间为0.67-1.47)。结论：低SES与老年乳腺癌患者的试验登记呈负相关，似乎解释了黑人患者和白人患者之间的登记差异。未来增加老年妇女参与癌症研究的努力应该明确与SES相关的障碍，这些障碍可能是可以干预的。(C)2004年美国癌症协会。
BACKGROUND. Older women, and older minorities in particular, are under represented in breast cancer trials. Although socioeconomic status (SES) is associated with both race and age, to the authors' knowledge little is known regarding the impact of SES on trial enrollment among older women with breast cancer.METHODS. The authors performed a case-control study comparing women who were participants in National Cancer Institute cooperative group breast cancer trials (cases) with a population-based sample of breast cancer patients (controls) obtained from the linked Surveillance, Epidemiology, and End Results (SEER)Medicare data base. The sample was restricted to women age greater than or equal to 65 years who were living in SEER areas. Proxies for SES included the proportion of the population below poverty level (by zip code) and unemployed (by county) as well those with Medicaid insurance coverage. A multivariable logistic regression model was used to test the association of SES with trial participation after accounting for other patient and county characteristics.RESULTS. In bivariate analysis, trial participants were significantly less likely than community cancer patients to reside in high-poverty zip codes (20.9% vs. 24.9%, respectively; P < 0.001) or to have Medicaid insurance (2.0% vs. 10.0%0; P < 0.0001). After adjusting for race, age, and county, trial participation remained inversely related to residing in areas with high poverty (odds ratio [OR] vs. residents of remaining counties, 0.78; 95% confidence interval [95% CI], 0.62-0.98), high unemployment rates (OR vs. residents of residents of counties in the lowest quartile, 0.50; 95% CI, 0.35-0.71), and having Medicaid insurance (OR vs. women without Medicaid, 0.22; 95% CI, 0.13-0.37); black race was not found to be related to trial participation (OR for black vs. white, 1.0; 95% CI, 0.67-1.47).CONCLUSIONS. Low SES was associated inversely with trial enrollment for older women with breast cancer and appeared to account for the enrollment disparities between black patients and white patients. Future efforts to enhance enrollment of elderly women in cancer research should specific barriers related to SES that may be amenable to intervention. (C) 2004 American Cancer Society.