Individual and neighborhood socioeconomic status and healthcare resources in relation to black-white breast cancer survival disparities.
Individual and neighborhood socioeconomic status and healthcare resources in relation to black-white breast cancer survival disparities.
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DOI：
10.1155/2013/490472
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发表时间：
2013
影响因子：
1.8
通讯作者：
Merajver S
中科院分区：
文献类型：
--
作者：
Akinyemiju TF;Soliman AS;Johnson NJ;Altekruse SF;Welch K;Banerjee M;Schwartz K;Merajver S
背景。在过去的10-15年里，美国乳腺癌患者的生存率有了显著提高。然而，黑人和白人女性的乳腺癌存活率存在差异。目的。探讨县卫生资源、社会经济地位及个体社会经济地位对黑人和白人妇女乳腺癌生存差异的影响。方法。来自1796例乳腺癌病例的数据来自监测流行病学和最终结果以及国家纵向死亡率研究数据集。建立了考虑县内聚类的Cox比例风险模型。三个序列Cox模型拟合每个结果，包括人口统计学变量；人口统计学和临床变量；最后是人口统计，临床和县级变量。结果。在未经调整的分析中，黑人女性死于乳腺癌的可能性比白人女性高53%，死于任何原因的可能性比白人女性高32% （P < 0.05）。调整人口统计学变量解释了种族对乳腺癌生存的影响（HR, 1.40; 95% CI, 0.99-1.97），但不能解释种族对全因死亡率的影响。在调整了县级变量后，全因生存的种族差异才消失（HR, 1.27； CI, 0.95-1.71）。结论。改善美国所有妇女获得医疗保健的公平机会可能有助于消除种族和社会经济群体之间的生存差距。
Background. Breast cancer survival has improved significantly in the US in the past 10–15 years. However, disparities exist in breast cancer survival between black and white women. Purpose. To investigate the effect of county healthcare resources and SES as well as individual SES status on breast cancer survival disparities between black and white women. Methods. Data from 1,796 breast cancer cases were obtained from the Surveillance Epidemiology and End Results and the National Longitudinal Mortality Study dataset. Cox Proportional Hazards models were constructed accounting for clustering within counties. Three sequential Cox models were fit for each outcome including demographic variables; demographic and clinical variables; and finally demographic, clinical, and county-level variables. Results. In unadjusted analysis, black women had a 53% higher likelihood of dying of breast cancer and 32% higher likelihood of dying of any cause (P < 0.05) compared with white women. Adjusting for demographic variables explained away the effect of race on breast cancer survival (HR, 1.40; 95% CI, 0.99–1.97), but not on all-cause mortality. The racial difference in all-cause survival disappeared only after adjusting for county-level variables (HR, 1.27; CI, 0.95–1.71). Conclusions. Improving equitable access to healthcare for all women in the US may help eliminate survival disparities between racial and socioeconomic groups.