Structural Racism and Breast Cancer-specific Survival
Structural Racism and Breast Cancer-specific Survival
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结构性种族主义和乳腺癌特异性生存
作者：
N. Goel;A. Westrick;Zinzi Bailey;Alexandra E Hernandez;R. Balise;Erica Goldfinger;M. Antoni;Justin Stoler;S. Kesmodel;E. Kobetz
目的：分析经济和种族/民族居住隔离对南佛罗里达州乳腺癌特异性生存(BCS)的影响，南佛罗里达州是一个多元化的大都市地区，反映了美国许多地区的人口预测。背景资料摘要：尽管在诊断和治疗方面取得了进展，但BCS的种族和经济差异。这项研究通过种族和经济居住隔离的视角来评估这些差异，这与结构性种族主义的影响大致相同。方法：对2005-2017年间在我所接受治疗的I-IV期乳腺癌患者进行回顾性队列研究。我们的风险敞口包括极端集中指数，这是一种衡量经济和种族社区隔离的指标，是在人口普查区域层面使用美国社区调查数据计算得出的。主要结果是BCS。结果：随机效应脆弱模型预测低收入社区的患者死亡率高于高收入社区的患者[危险比(HR)：1.56，95%可信区间(CI)：1.23-2.00]。在控制了患者特征后，居住在低收入非西班牙裔黑人和西班牙裔社区的患者的死亡率分别高于生活在高收入非西班牙裔白人社区的患者(HR：2.43，95%CI：1.72，3.43)和(HR：1.99，95%CI：1.39，2.84)。在调整的种族分层分析中，生活在低收入非西班牙裔黑人社区的卫生工作者的死亡率高于生活在高收入非西班牙裔黑人社区的卫生工作者(HR：4.09，95%CI：2.34-7.06)。结论：极端的种族/民族和经济隔离与较低的BCS有关。我们为越来越多的文献增加了关于nhw和西班牙裔的新见解，这些文献展示了结构性种族主义-通过贫困和居住隔离-的生态影响如何塑造癌症存活率。
Objective: To analyze the effect of economic and racial/ethnic residential segregation on breast cancer-specific survival (BCSS) in South Florida, a diverse metropolitan area that mirrors the projected demographics of many United States regions. Summary Background Data: Despite advances in diagnosis and treatment, racial and economic disparities in BCSS. This study evaluates these disparities through the lens of racial and economic residential segregation, which approximate the impact of structural racism. Methods: Retrospective cohort study of stage I to IV breast cancer patients treated at our institution from 2005 to 2017. Our exposures include index of concentration at the extremes, a measurement of economic and racial neighborhood segregation, which was computed at the census-tract level using American Community Survey data. The primary outcome was BCSS. Results: Random effects frailty models predicted that patients living in low-income neighborhoods had higher mortality compared to those living in high-income neighborhoods [hazard ratios (HR): 1.56, 95% confidence interval (CI): 1.23–2.00]. Patients living in low-income non-Hispanic Black and Hispanic neighborhoods had higher mortality compared to those living in high-income non-Hispanic White (NHW) neighborhoods (HR: 2.43, 95%CI: 1.72, 3.43) and (HR: 1.99, 95%CI: 1.39, 2.84), after controlling for patient characteristics, respectively. In adjusted race-stratified analysis, NHWs living in low-income non-Hispanic Black neighborhoods had higher mortality compared to NHWs living in high-income NHW neighborhoods (HR: 4.09, 95%CI: 2.34–7.06). Conclusions: Extreme racial/ethnic and economic segregation were associated with lower BCSS. We add novel insight regarding NHW and Hispanics to a growing body of literature that demonstrate how the ecological effects of structural racism—expressed through poverty and residential segregation—shape cancer survival.
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影响因子：
4.9
作者：
Spielman, Seth E.;Folch, David;Nagle, Nicholas
通讯作者：
Nagle, Nicholas
影响因子：
12.7
作者：
Abraído-Lanza, AF;Dohrenwend, BP;Turner, JB
通讯作者：
Turner, JB
影响因子：
5.4
作者：
Abraído-Lanza, AF;Chao, MT;Flórez, KR
通讯作者：
Flórez, KR
影响因子：
5.4
作者：
Osypuk, Theresa L.;Roux, Ana V. Diez;Hadley, Craig;Kandula, Namratha R.
通讯作者：
Kandula, Namratha R.
影响因子：
45.3
作者：
Ellis, Libby;Canchola, Alison J.;Gomez, Scarlett Lin
通讯作者：
Gomez, Scarlett Lin