PDF(Sci-hub)
Abstract：
Breast cancer is the leading cause of cancer deaths among women in the Caribbean and accounts for >1 million disability adjusted life years. Little is known about the social inequalities of this disease in the Caribbean. In support of the Rio Political Declaration on addressing health inequities, this article presents a systematic review of evidence on the distribution, by social determinants, of breast cancer risk factors, frequency, and adverse outcomes in Caribbean women.
MEDLINE, EMBASE, SciELO, CINAHL, CUMED, LILACS, and IBECS were searched for observational studies reporting associations between social determinants and breast cancer risk factors, frequency, or outcomes. Based on the PROGRESS-plus checklist, we considered 8 social determinant groups for 14 breast cancer endpoints, which totalled to 189 possible ways (\'relationship groups\') to explore the role of social determinants on breast cancer. Studies with >50 participants conducted in Caribbean territories between 2004 and 2014 were eligible for inclusion. The review was conducted according to STROBE and PRISMA guidelines and results were planned as a narrative synthesis, with meta-analysis if possible.
Thirty-four articles were included from 5,190 screened citations. From these included studies, 75 inequality relationships were reported examining 30 distinct relationship groups, leaving 84% of relationship groups unexplored. Most inequality relationships were reported for risk factors, particularly alcohol and overweight/obesity which generally showed a positive relationship with indicators of lower socioeconomic position. Evidence for breast cancer frequency and outcomes was scarce. Unmarried women tended to have a higher likelihood of being diagnosed with breast cancer when compared to married women. While no association was observed between breast cancer frequency and ethnicity, mortality from breast cancer was shown to be slightly higher among Asian-Indian compared to African-descent populations in Trinidad (OR 1.2, 95% CI 1.1-1.4) and Guyana (OR 1.3, 95% CI 1.0-1.6).
Study quantity, quality, and variability in outcomes and reporting limited the synthesis of evidence on the role of social determinants on breast cancer in the Caribbean. This report represents important current evidence on the region, and can guide future research priorities for better describing and understanding of Caribbean breast cancer inequalities.
MEDLINE, EMBASE, SciELO, CINAHL, CUMED, LILACS, and IBECS were searched for observational studies reporting associations between social determinants and breast cancer risk factors, frequency, or outcomes. Based on the PROGRESS-plus checklist, we considered 8 social determinant groups for 14 breast cancer endpoints, which totalled to 189 possible ways (\'relationship groups\') to explore the role of social determinants on breast cancer. Studies with >50 participants conducted in Caribbean territories between 2004 and 2014 were eligible for inclusion. The review was conducted according to STROBE and PRISMA guidelines and results were planned as a narrative synthesis, with meta-analysis if possible.
Thirty-four articles were included from 5,190 screened citations. From these included studies, 75 inequality relationships were reported examining 30 distinct relationship groups, leaving 84% of relationship groups unexplored. Most inequality relationships were reported for risk factors, particularly alcohol and overweight/obesity which generally showed a positive relationship with indicators of lower socioeconomic position. Evidence for breast cancer frequency and outcomes was scarce. Unmarried women tended to have a higher likelihood of being diagnosed with breast cancer when compared to married women. While no association was observed between breast cancer frequency and ethnicity, mortality from breast cancer was shown to be slightly higher among Asian-Indian compared to African-descent populations in Trinidad (OR 1.2, 95% CI 1.1-1.4) and Guyana (OR 1.3, 95% CI 1.0-1.6).
Study quantity, quality, and variability in outcomes and reporting limited the synthesis of evidence on the role of social determinants on breast cancer in the Caribbean. This report represents important current evidence on the region, and can guide future research priorities for better describing and understanding of Caribbean breast cancer inequalities.
摘要：
乳腺癌是加勒比地区妇女癌症死亡的主要原因，并占超过100万残疾调整寿命年。人们对加勒比地区这种疾病的社会不平等知之甚少。支持关于解决健康不平等的里约政治宣言，本文对分布的证据进行了系统的回顾，根据社会决定因素，乳腺癌的危险因素，频率,和加勒比妇女的不良后果。
MEDLINE,EMBASE,SciELO,CINAHL,CUMED,LILACS,和IBECS被搜索的观察性研究报告社会决定因素和乳腺癌危险因素之间的关联，频率,或结果。根据PROGRESS-plus检查表，我们考虑了14个乳腺癌终点的8个社会决定因素组，总共有189种可能的方法(“关系组”)来探索社会决定因素对乳腺癌的作用。2004年至2014年期间在加勒比地区进行的超过50名参与者的研究符合纳入条件。审查是根据STROBE和PRISMA指南进行的，并计划将结果作为叙述性综合，如果可能的话，进行荟萃分析。
从5,190篇筛选的引文中纳入了34篇文章。从这些纳入的研究中，据报道，75个不平等关系检查了30个不同的关系组，留下84%的关系组未经探索。大多数不平等关系都是针对风险因素报告的，特别是酒精和超重/肥胖，通常与社会经济地位较低的指标呈正相关。乳腺癌频率和预后的证据很少。与已婚妇女相比，未婚妇女被诊断出患有乳腺癌的可能性更高。虽然没有观察到乳腺癌频率和种族之间的关联，与特立尼达(OR1.2,95%CI1.1-1.4)和圭亚那(OR1.3,95%CI1.0-1.6)的非洲裔人群相比,亚洲-印度人的乳腺癌死亡率略高.
研究数量，质量,结果和报告的可变性限制了加勒比地区社会决定因素对乳腺癌作用的综合证据。这份报告代表了该地区当前的重要证据，并可以指导未来的研究重点，以更好地描述和理解加勒比乳腺癌的不平等。
MEDLINE,EMBASE,SciELO,CINAHL,CUMED,LILACS,和IBECS被搜索的观察性研究报告社会决定因素和乳腺癌危险因素之间的关联，频率,或结果。根据PROGRESS-plus检查表，我们考虑了14个乳腺癌终点的8个社会决定因素组，总共有189种可能的方法(“关系组”)来探索社会决定因素对乳腺癌的作用。2004年至2014年期间在加勒比地区进行的超过50名参与者的研究符合纳入条件。审查是根据STROBE和PRISMA指南进行的，并计划将结果作为叙述性综合，如果可能的话，进行荟萃分析。
从5,190篇筛选的引文中纳入了34篇文章。从这些纳入的研究中，据报道，75个不平等关系检查了30个不同的关系组，留下84%的关系组未经探索。大多数不平等关系都是针对风险因素报告的，特别是酒精和超重/肥胖，通常与社会经济地位较低的指标呈正相关。乳腺癌频率和预后的证据很少。与已婚妇女相比，未婚妇女被诊断出患有乳腺癌的可能性更高。虽然没有观察到乳腺癌频率和种族之间的关联，与特立尼达(OR1.2,95%CI1.1-1.4)和圭亚那(OR1.3,95%CI1.0-1.6)的非洲裔人群相比,亚洲-印度人的乳腺癌死亡率略高.
研究数量，质量,结果和报告的可变性限制了加勒比地区社会决定因素对乳腺癌作用的综合证据。这份报告代表了该地区当前的重要证据，并可以指导未来的研究重点，以更好地描述和理解加勒比乳腺癌的不平等。
