Impact of individual and neighborhood factors on disparities in prostate cancer survival
Impact of individual and neighborhood factors on disparities in prostate cancer survival
复制标题
DOI：
10.1016/j.canep.2018.01.003
复制
发表时间：
2018-04-01
影响因子：
2.6
通讯作者：
Gomez, Scarlett L.
中科院分区：
文献类型：
--
作者：
DeRouen, Mindy C.;Schupp, Clayton W.;Gomez, Scarlett L.
背景资料：我们提出了这样一个假设，即个体水平因素与社会和建筑环境因素共同作用，影响前列腺癌男性患者的总体生存率，并导致种族/民族和社会经济（SES）生存差异。我们分析了多水平数据，结合（1）来自加州前列腺癌合作研究的个体水平数据，该研究是一项基于人群的研究，包括非西班牙裔白色人（NHW）、西班牙裔人、1997年至2003年诊断的非裔美国人前列腺癌病例（N= 1800），（2）来自加州社区数据系统的社区SES（nSES）和社会及建筑环境因素的数据，（3）来自加州癌症登记处的肿瘤特征、治疗和随访至2009年的数据。多变量，阶段分层的考克斯比例风险回归模型与集群调整，评估教育和nSES的主要和联合的影响，总生存率，调整前和调整后的社会和建成环境factors.Results：非裔美国人的生存比NHW男性，这是衰减的nSES。死亡风险增加与居住在较低社会经济地位的社区（五分位1（最低nSES）vs. 5：HR= 1.56，95% CI：1.11-2.19）和教育程度较低（<高中vs.大学：HR= 1.32，95% CI：1.05-1.67）相关，并观察到低教育和低nSES的联合关联。调整行为，医院，餐厅和食品环境的特点只有轻微衰减SES和survival.Conclusion之间的这些关联：个人和背景水平的SES影响前列腺癌男性的总体生存。需要更多的研究来确定这些强大的关联背后的机制。
Background: We addressed the hypothesis that individual-level factors act jointly with social and built environment factors to influence overall survival for men with prostate cancer and contribute to racial/ethnic and socioeconomic (SES) survival disparities.Methods: We analyzed multi-level data, combining (1) individual-level data from the California Collaborative Prostate Cancer Study, a population-based study of non-Hispanic White (NHW), Hispanic, and African American prostate cancer cases (N= 1800) diagnosed from 1997 to 2003, with (2) data on neighborhood SES (nSES) and social and built environment factors from the California Neighborhoods Data System, and (3) data on tumor characteristics, treatment and follow-up through 2009 from the California Cancer Registry. Multivariable, stage-stratified Cox proportional hazards regression models with cluster adjustments were used to assess education and nSES main and joint effects on overall survival, before and after adjustment for social and built environment factors.Results: African American men had worse survival than NHW men, which was attenuated by nSES. Increased risk of death was associated with residence in lower SES neighborhoods (quintile 1 (lowest nSES) vs. 5: HR= 1.56, 95% CI: 1.11-2.19) and lower education (< high school vs. college: HR= 1.32, 95% CI: 1.05-1.67), and a joint association of low education and low nSES was observed. Adjustment for behavioral, hospital, and restaurant and food environment characteristics only slightly attenuated these associations between SES and survival.Conclusion: Both individual-and contextual-level SES influence overall survival of men with prostate cancer. Additional research is needed to identify the mechanisms underlying these robust associations.