Comorbidity and survival disparities among black and white patients with breast cancer
Comorbidity and survival disparities among black and white patients with breast cancer
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DOI：
10.1001/jama.294.14.1765
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发表时间：
2005-10-12
影响因子：
120.7
通讯作者：
Nathanson, D
中科院分区：
文献类型：
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作者：
Tammemagi, CM;Nerenz, D;Nathanson, D
背景 与白人乳腺癌患者相比，黑人乳腺癌患者生存期较短的原因尚不完全清楚。目的 评估合并症在乳腺癌患者种族差异中的作用。设计、环境和患者 来自亨利·福特医疗系统（密歇根州底特律的一个大型综合医疗系统）的历史队列随访时间中位数为 10 年。患者 (n=906) 包括 1985 年至 1990 年间被诊断患有乳腺癌的 264 名黑人 (29.1%) 和 642 名白人 (70.9%) 女性。详细的合并症数据 (268 种合并症) 和研究数据摘自医疗记录和机构、监测、流行病学和最终结果以及密歇根州登记处。使用 Logistic 和 Cox 回归分析关联性。主要结果指标乳腺癌复发/进展以及所有乳腺癌和竞争性（非乳腺癌）原因导致的死亡的存活率。结果在黑人中，64 人 (24.9%) 死于乳腺癌，95 人 (37.0%) 死于竞争原因。白人的可比数据为 115 (18.3%) 和 202 (32.1%)。黑人的全因生存率（风险比 [HR]，1.34；95% 置信区间 [CI]，1.11-1.62）、乳腺癌特异性生存率（HR，1.47；95% CI，1.08-2.00）和竞争原因生存率（HR，1.27；95% CI，1.00-1.63）较差。总共 77 种不良合并症与生存率降低相关。不良合并症计数与全因生存（调整后 HR，1.29；95% CI，1.19-1.40）和竞争原因生存相关，但与复发/进展或乳腺癌特异性生存无关。在 221 名 (86.0%) 黑人和 407 名 (65.7%) 白人中观察到至少 1 种不良合并症（比值比，3.20；95% CI，2.17-4.72）。未调整和合并症调整 HR 的比较表明，不良合并症解释了 49.1% 的全因生存差异和 76.7% 的竞争原因生存差异。糖尿病和高血压在解释差异方面尤其重要。 结论 死于竞争原因的黑人乳腺癌患者多于死于乳腺癌的黑人乳腺癌患者。有效控制黑人乳腺癌患者的合并症应有助于提高预期寿命并减少生存差异。
Context Reasons for the shorter survival of black breast cancer patients compared with their white counterparts are not completely understood.Objective To evaluate the role of comorbidity in this racial disparity among breast cancer patients.Design, Setting, and Patients Historical cohort from the Henry Ford Health System (a large comprehensive health system in Detroit, Mich) followed up for a median of 10 years. Patients (n=906) included 264 black (29.1%) and 642 white (70.9%) women diagnosed as having breast cancer between 1985 and 1990. Detailed comorbidity data (268 comorbidities) and study data were abstracted from medical records and institutional, Surveillance, Epidemiology, and End Results, and Michigan State registries. Associations were analyzed with logistic and Cox regression.Main Outcome Measures Breast cancer recurrence/progression and survival to death from all, breast cancer, and competing (non-breast cancer) causes.Results Of blacks, 64 (24.9%) died of breast cancer and 95 (37.0%) died of competing causes. Comparable data for whites were 115 (18.3%) and 202 (32.1%). Blacks had worse all-cause survival (hazard ratio [HR], 1.34; 95% confidence interval [CI], 1.11-1.62), breast cancer-specific survival (HR, 1.47; 95% CI, 1.08-2.00), and competing causes survival (HR, 1.27; 95% CI, 1.00-1.63). A total of 77 adverse comorbidities were associated with reduced survival. Adverse comorbidity count was associated with all-cause (adjusted HR, 1.29; 95% CI, 1.19-1.40) and competing-causes survival but was not associated with recurrence/progression or breast cancer-specific survival. At least 1 adverse comorbidity was observed in 221 (86.0%) blacks and 407 (65.7%) whites (odds ratio, 3.20; 95% CI, 2.17-4.72). Comparisons of unadjusted and comorbidity-adjusted HRs indicated that adverse comorbidity explained 49.1% of all-cause and 76.7% of competing-causes survival disparity. Diabetes and hypertension, were particularly important in explaining disparity.Conclusions More black breast cancer patients die of competing causes than-of breast cancer. Effective control of comorbidity in black breast cancer patients should help improve life expectancy and lead to a reduction in survival disparities.