Racial disparities in individual breast cancer outcomes by hormone-receptor subtype, area-level socio-economic status and healthcare resources.
Racial disparities in individual breast cancer outcomes by hormone-receptor subtype, area-level socio-economic status and healthcare resources.
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DOI：
10.1007/s10549-016-3840-x
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发表时间：
2016-06
影响因子：
3.8
通讯作者：
Altekruse SF
中科院分区：
文献类型：
--
作者：
Akinyemiju T;Moore JX;Ojesina AI;Waterbor JW;Altekruse SF
该研究的目的是确定区域水平的社会经济地位和医疗保健的影响，除了肿瘤受体亚型对个体乳腺癌的阶段，治疗和非西班牙裔（NH）-黑人，NH-白人和西班牙裔美国成年人的死亡率。分析基于2000年至2010年SEER数据库中的456，217例乳腺癌患者。进行多水平和多变量校正的logistic和考克斯比例风险回归分析，以解释SEER诊断登记处的聚类。与其他种族的妇女相比，新罕布什尔州黑人妇女在地区一级获得医疗保健资源的机会更大。例如，在拥有新卫生黑人、新卫生白人和西班牙裔妇女的县，每百万人口中肿瘤医院的平均数量分别为8.1、7.7和5.0;在拥有新卫生黑人、新卫生白人和西班牙裔妇女的县，每百万人口中医生的平均数量分别为100.7、854.0和866.3;新罕布什尔州黑人、白人和西班牙裔妇女的平均妇产科人数分别为155.6、127.4和127.3（所有p值均<0.001）。无论如何，即使在调整了受体亚型、地区社会经济地位和地区医疗保健可及性之后，与新罕布什尔州白人女性相比，新罕布什尔州黑人女性（HR 1.39，95%CI 1.36-1.43）和西班牙裔女性（HR 1.05，95%CI 1.03-1.08）的乳腺癌死亡率也显著较高。此外，较低的县级社会经济地位和医疗保健可及性指标与就诊时的分期、手术和放射治疗以及经年龄、人种/种族和HR亚型调整后的死亡率显著且独立相关。虽然乳腺癌HR亚型是乳腺癌预后的一个强有力的、重要的和一致的预测因子，但我们仍然观察到地区水平的SES和HCA对乳腺癌预后的显著和独立的影响，值得进一步研究，这可能对消除乳腺癌预后差异至关重要。
The aim of the study is to determine the influence of area-level socio-economic status and healthcare access in addition to tumor hormone-receptor subtype on individual breast cancer stage, treatment, and mortality among Non-Hispanic (NH)-Black, NH-White, and Hispanic US adults. Analysis was based on 456,217 breast cancer patients in the SEER database from 2000 to 2010. Multilevel and multivariable-adjusted logistic and Cox proportional hazards regression analysis was conducted to account for clustering by SEER registry of diagnosis. NH-Black women had greater area-level access to healthcare resources compared with women of other races. For instance, the average numbers of oncology hospitals per million population in counties with NH-Black, NH-White, and Hispanic women were 8.1, 7.7, and 5.0 respectively; average numbers of medical doctors per million in counties with NH-Black, NH-White, and Hispanic women were 100.7, 854.0, and 866.3 respectively; and average number of Ob/Gyn in counties with NH-Black, NH-White, and Hispanic women was 155.6, 127.4, and 127.3, respectively (all p values <0.001). Regardless, NH-Black women (HR 1.39, 95 % CI 1.36–1.43) and Hispanic women (HR 1.05, 95 % CI 1.03–1.08) had significantly higher breast cancer mortality compared with NH-White women even after adjusting for hormone-receptor subtype, area-level socioeconomic status, and area-level healthcare access. In addition, lower county-level socio-economic status and healthcare access measures were significantly and independently associated with stage at presentation, surgery, and radiation treatment as well as mortality after adjusting for age, race/ethnicity, and HR subtype. Although breast cancer HR subtype is a strong, important, and consistent predictor of breast cancer outcomes, we still observed significant and independent influences of area-level SES and HCA on breast cancer outcomes that deserve further study and may be critical to eliminating breast cancer outcome disparities.