Examining the effect of minority status and neighborhood characteristics on cervical cancer survival outcomes
Examining the effect of minority status and neighborhood characteristics on cervical cancer survival outcomes
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DOI：
10.1016/j.ygyno.2010.11.041
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发表时间：
2011-04-01
影响因子：
4.7
通讯作者：
Ashing-Giwa, Kimlin T.
中科院分区：
文献类型：
--
作者：
Lim, Jung-won;Ashing-Giwa, Kimlin T.
Objective.了解导致死亡率和生存率的因素是健康结果研究的核心。本研究的目的是调查：（1）生存状态的种族和邻里中位数收入水平的差异;（2）个人和邻里水平的因素影响宫颈癌生存。这项研究是基于1811例宫颈癌病例的数据，这些病例是通过加州癌症监测项目获得的。因变量为自癌症诊断之日起的生存天数。从2000年人口普查数据中获得了基于邮政编码的邻里水平变量。种族与生存率显著相关（chi（2）= 20.58：p < 0.001），非洲裔美国人的生存率最短。欧洲、非洲、拉丁美洲和亚裔美国患者所有分期的5年生存率分别为85%、75%、85%和84%。没有观察到高收入和低收入地区之间的生存差异。然而，当考虑种族时，生活在高收入地区的亚裔美国人比低收入社区的亚裔美国人的生存时间更长（chi（2）= 4.531; p < 0.05）。多水平模型显示，种族，诊断时的年龄，和手术分层的癌症分期与宫颈癌生存率在个体水平显着相关。在社区层面上，居住在非裔美国人比例高的社区，死亡风险增加了1%。邻里环境可能是一个有影响力的贡献者生存的亚裔和非洲裔美国人特别。这些发现需要更仔细地研究种族和社区对癌症生存的独特贡献，以解开种族群体成员，社会生态环境和压力以及医疗因素对疾病结局的作用。(C)2010年爱思唯尔公司All rights reserved.
Objective. Understanding the factors that contribute to mortality and survival is central to health outcome research. The purpose of this study was to investigate the following: (1) differences in survival status by ethnicity and neighborhood median income level; and (2) individual- and neighborhood-level factors influencing cervical cancer survival.Methods. This study was based on data from 1811 cervical cancer cases obtained through the California Cancer Surveillance Program. The dependent variable was days of survival from date of cancer diagnosis. Zip code-based neighborhood-level variables were obtained from Census 2000 data.Results. Ethnicity was significantly associated with survival (chi(2) = 20.58: p < 0.001), with African-Americans showing the shortest survival. The 5-year survival rates of European-, African-, Latino-, and Asian-American patients for all stages combined were 85%, 75%, 85%, and 84%, respectively. Differences in survival between high- and low-income regions were not observed. However, when ethnicity was considered, Asian-Americans who lived in high-income regions showed longer survival than their low-income community counterparts (chi(2) = 4.531; p < 0.05). The multilevel model demonstrated ethnicity, age at diagnosis, and cancer stage stratified by surgery to be significantly associated with cervical cancer survival at the individual level. At the neighborhood level, residing in neighborhoods with a high proportion of African-Americans increased the risk of death by 1%.Conclusions. The neighborhood context may be an influential contributor to survival for Asian- and African-Americans specifically. These findings necessitate closer examination of the unique contribution of ethnicity and neighborhood on cancer survival to disentangle the role of ethnic group membership, socio-ecological contexts and stress, and medical factors on disease outcomes. (C) 2010 Elsevier Inc. All rights reserved.