The Influence of Medical Comorbidities on Survival Disparities in a Multiethnic Group of Patients with De Novo Metastatic Breast Cancer.
The Influence of Medical Comorbidities on Survival Disparities in a Multiethnic Group of Patients with De Novo Metastatic Breast Cancer.
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合并症对多种族新发转移性乳腺癌患者生存差异的影响。
DOI：
10.1158/1055-9965.epi-22-0065
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Haque,Reina
中科院分区：
文献类型：
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作者：
Wallner,LaurenP;Chen,LieH;Hogan,TiffanyA;Brasfield,FarahM;Haque,Reina
背景：常见医学合并症对转移性乳腺癌妇女死亡率的影响以及种族/民族死亡率差异在很大程度上仍然未知。方法在这项纵向研究中，从2009年1月至2017年12月（n= 995）在一个大型、多样化、综合的医疗保健服务系统中发现了新诊断的IV期乳腺癌妇女，并通过电子健康记录追踪到2018年12月31日的全因（总体）和乳腺癌特异性死亡率。我们按种族/民族和Elixhauser合并症指数（ECI）计算了总体和乳腺癌特异性死亡率。多变量校正风险比（HR）评估种族/民族和合并症状况对总体和乳腺癌特异性死亡率的影响，使用调整年龄、乳腺癌亚型、地理编码收入和姑息性癌症治疗的比例风险回归来估计。结果近17%的患者患有糖尿病，45%的患者患有高血压。总体而言，队列中发生了644例死亡（中位随访时间为1.8年），其中88%与乳腺癌相关。与白人妇女相比，亚洲/太平洋岛民（PI；调整后的HR = 1.45; 95% CI, 1.10-1.92）和非洲裔美国人/黑人妇女（调整后的HR = 1.34; 95% CI, 1.02-1.76）的总死亡风险增加。有更多合并症（ECI≥5）的妇女的总死亡率比没有任何合并症的妇女高3倍以上[602/ 1000人年（PY） vs. 175/ 1000 PY]。乳腺癌特异性死亡率也发现了类似的关联。医学合并症与新发转移性疾病女性总体死亡率风险增加相关，并可能影响死亡率的种族差异。影响：优化转移性乳腺癌患者合并症的管理也可能有助于减少乳腺癌相关死亡率的差异。
BackgroundThe influence of common medical comorbidities on mortality and racial/ethnic disparities in mortality among women with metastatic breast cancer remains largely unknown.MethodsIn this longitudinal study, women with newly diagnosed stage IV breast cancer were identified in a large, diverse, integrated healthcare delivery system from January 2009 to December 2017 (n= 995) and followed through December 31, 2018, for all-cause (overall) and breast cancer–specific mortality via electronic health records. We computed overall and breast cancer–specific mortality rates by race/ethnicity and Elixhauser comorbidity index (ECI). Multivariable-adjusted hazard ratios (HR) assessing the influence of race/ethnicity and comorbidity status on overall and breast cancer–specific mortality were estimated using proportional hazards regression adjusted for age, breast cancer subtype, geocoded income, and palliative cancer treatments.ResultsNearly 17% of this cohort had diabetes and 45% had hypertension. Overall, 644 deaths occurred in the cohort (median follow-up time of 1.8 years), of which 88% were breast cancer related. The risk of overall mortality was increased in Asian/Pacific Islander (PI; adjusted HR = 1.45; 95% CI, 1.10–1.92) and African American/Black women (adjusted HR = 1.34; 95% CI, 1.02–1.76) when compared with white women. Women with more comorbidities (ECI ≥ 5) had more than 3-fold higher overall mortality rate than those without any comorbidities [602/1,000 person-year (PY) vs. 175/1,000 PY]. Similar associations were found for breast cancer–specific mortality.ConclusionsMedical comorbidities are associated with an increased risk of overall mortality among women with de novo metastatic disease and may influence racial/ethnic disparities in mortality.ImpactOptimizing the management of medical comorbidities in metastatic breast cancer patients may also help reduce disparities in breast cancer–related mortality.