Breast cancer treatment delays by socioeconomic and health care access latent classes in Black and White women.
Breast cancer treatment delays by socioeconomic and health care access latent classes in Black and White women.
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黑人和白色妇女的社会经济和卫生保健获得潜在阶层导致乳腺癌治疗延迟。
DOI：
10.1002/cncr.33121
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发表时间：
2020-11-15
期刊：
影响因子：
6.2
通讯作者：
Troester MA
中科院分区：
文献类型：
--
作者：
Emerson MA;Golightly YM;Aiello AE;Reeder-Hayes KE;Tan X;Maduekwe U;Johnson-Thompson M;Olshan AF;Troester MA
黑人和年轻妇女的乳腺癌死亡率较高。这项研究评估了两个可能的差异贡献者-治疗时间和治疗持续时间-按种族和年龄。在卡罗莱纳乳腺癌研究的2,841名I-III期患者中，我们使用潜在类别分析确定了具有相似社会经济地位（SES）模式、获得护理和肿瘤特征的女性群体。然后，我们评估了与治疗延迟（诊断后>60天开始）和治疗持续时间（按治疗方式的四分位数）相关的潜在类别。32%的年轻黑人女性处于治疗持续时间的最高四分位数（而年轻白人为22%）。黑人女性延迟治疗的频率更高[校正的相对频率差（RFD）= 5.5%; 95%置信区间（CI）：3.2%，7.8%）]和治疗持续时间延长（RFD = 8.8%; 95% CI：5.7%，12.0%）。低SES与白色女性的治疗延迟显著相关（RFD 3.5%; 95% CI：1.1，5.9），但黑人女性的治疗延迟在所有SES水平上都很高（例如，高SES黑人女性的治疗延迟率为11.7%，而低和高SES白人的治疗延迟率分别为10.6%和6.7%）。无论是SES还是获得护理类显着相关的黑人妇女延迟启动，但低SES和更多的障碍与治疗时间在两个种族。影响治疗及时性的因素在整个护理过程中持续存在，延长治疗时间是种族，SES和护理障碍差异的敏感指标。经济和其他障碍，照顾似乎复合在整个连续体，治疗时间是一个敏感的指标，照顾的障碍。通过对影响病程的多种患者因素进行综合分析，可以将适当的多维度干预措施概念化，以减少种族死亡率差异。
Breast cancer mortality is higher for black and younger women. This study evaluated two possible contributors to disparities -- time to treatment and treatment duration -- by race and age. Among 2,841 participants with stage I-III disease in the Carolina Breast Cancer Study, we identified groups of women with similar patterns of socioeconomic status (SES), access to care, and tumor characteristics using latent class analysis. We then evaluated latent classes in association with treatment delay (initiation >60 days after diagnosis) and treatment duration (in quartiles by treatment modality). Thirty-two percent of younger black women were in the highest quartile of treatment duration (versus 22% of younger whites). Black women experienced a higher frequency of delayed treatment [adjusted relative frequency difference (RFD) = 5.5%; 95% confidence interval (CI): 3.2%, 7.8%)] and prolonged treatment duration (RFD = 8.8%; 95% CI: 5.7%, 12.0%). Low SES was significantly associated with treatment delay among white women (RFD 3.5%; 95% CI: 1.1, 5.9), but treatment delay was high at all levels of SES in black women (e.g. 11.7% in high SES black women compared to 10.6% and 6.7% among low and high SES whites, respectively). Neither SES nor access to care classes were significantly associated with delayed initiation among black women, but both low SES and more barriers were associated with treatment duration across both races. Factors that influence treatment timeliness persist throughout the care continuum, with prolonged treatment duration being a sensitive indicator of differences by race, SES, and care barriers. Economic and other barriers to care appear to compound across the continuum, with treatment duration representing a sensitive indicator of barriers to care. By developing an integrated view of multiple patient factors that contribute to duration, appropriate multidimensional interventions can be conceptualized to reduce racial mortality disparities.
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影响因子：
1.4
作者：
Fedewa, Stacey A.;Edge, Stephen B.;Ward, Elizabeth M.
通讯作者：
Ward, Elizabeth M.
影响因子：
254.7
作者：
DeSantis, Carol E.;Fedewa, Stacey A.;Jemal, Ahmedin
通讯作者：
Jemal, Ahmedin
影响因子：
45.3
作者：
Freedman, Rachel A.;He, Yulei;Keating, Nancy L.
通讯作者：
Keating, Nancy L.
DOI：
10.1093/jnci/djg073
发表时间：
2003-10-15
期刊：
JOURNAL OF THE NATIONAL CANCER INSTITUTE
影响因子：
--
作者：
Hershman, D;Weinberg, M;Neugut, AI
通讯作者：
Neugut, AI
影响因子：
3.8
作者：
Akinyemiju T;Moore JX;Ojesina AI;Waterbor JW;Altekruse SF
通讯作者：
Altekruse SF