■邻里剥夺与白人女性乳腺癌死亡率增加有关,但是黑人女性的调查结果不一致,他们经历了不同的邻里环境。考虑到邻里剥夺之间的相互作用,种族,和其他邻域特征可以增强对关联的理解。
■为了调查黑人和白人女性中邻里剥夺是否与乳腺癌死亡率相关,以及是否与乡村行为相互作用,住宅移动性,和种族组成,它们是访问的标记,社会凝聚力,和隔离,分别,修改关联。
■这项基于人群的队列研究使用了佐治亚州癌症登记处(GCR)2010年至2017年诊断为乳腺癌的女性数据,并随访至2022年12月31日。数据在2023年1月至2023年10月之间进行了分析。该研究包括2010年至2017年间诊断并通过GCR鉴定的非西班牙裔黑人和白人女性浸润性早期(I-IIIA)乳腺癌。
■邻里剥夺指数(NDI),以五分位数进行评估,是通过对2011年至2015年区块组级美国社区调查(ACS)数据的主成分分析得出的。Rurality,邻里住宅移动性,和种族构成使用佐治亚州公共卫生部或ACS数据进行测量。
■主要结果是GCR通过与佐治亚州生命统计注册表和国家死亡指数的联系确定的乳腺癌特异性死亡率。Cox比例风险回归用于估计年龄调整和多变量调整的风险比(HR)和95%CI,以评估邻域剥夺与乳腺癌死亡率之间的关联。
■在36795例乳腺癌患者中(诊断时的平均[SD]年龄,60.3[13.1]年),11044(30.0%)是非西班牙裔黑人,和25751(70.0%)是非西班牙裔白人。随访期间,发生2942例乳腺癌死亡(1214例[41.3%]非西班牙裔黑人女性;1728例[58.7%]非西班牙裔白人女性)。NDI与乳腺癌死亡率的增加相关(5比1,HR,1.36;95%CI,1.19-1.55)在Cox比例风险模型中。该关联仅存在于非西班牙裔白人女性中(五分之一5vs1,HR,1.47;95%CI,1.21-1.79)。在联合分层分析中观察到类似的种族特定模式,因此,NDI与非西班牙裔白人女性乳腺癌死亡率增加有关,但不是非西班牙裔黑人女性,不考虑其他邻居特征。
■在这项队列研究中,社区贫困与非西班牙裔白人女性乳腺癌死亡率增加相关.邻里种族组成,住宅移动性,农村并不能解释非西班牙裔黑人女性之间缺乏联系,这表明,在这个种族群体中,超出这些因素的因素可能会导致乳腺癌的死亡率。
UNASSIGNED: Neighborhood deprivation has been associated with increased breast cancer mortality among White women, but findings are inconsistent among Black women, who experience different neighborhood contexts. Accounting for interactions among neighborhood deprivation, race, and other neighborhood characteristics may enhance understanding of the association.
UNASSIGNED: To investigate whether neighborhood deprivation is associated with breast cancer mortality among Black and White women and whether interactions with rurality, residential mobility, and racial composition, which are markers of access, social cohesion, and segregation, respectively, modify the association.
UNASSIGNED: This population-based cohort study used Georgia Cancer Registry (GCR) data on women with breast cancer diagnosed in 2010 to 2017 and followed-up until December 31, 2022. Data were analyzed between January 2023 and October 2023. The study included non-Hispanic Black and White women with invasive early-stage (I-IIIA) breast cancer diagnosed between 2010 and 2017 and identified through the GCR.
UNASSIGNED: The Neighborhood Deprivation Index (NDI), assessed in quintiles, was derived through principal component analysis of 2011 to 2015 block group-level American Community Survey (ACS) data. Rurality, neighborhood residential mobility, and racial composition were measured using Georgia Public Health Department or ACS data.
UNASSIGNED: The primary outcome was breast cancer-specific mortality identified by the GCR through linkage to the Georgia vital statistics registry and National Death Index. Cox proportional hazards regression was used to estimate age-adjusted and multivariable-adjusted hazard ratios (HRs) and 95% CIs for the association between neighborhood deprivation and breast cancer mortality.
UNASSIGNED: Among the 36 795 patients with breast cancer (mean [SD] age at diagnosis, 60.3 [13.1] years), 11 044 (30.0%) were non-Hispanic Black, and 25 751 (70.0%) were non-Hispanic White. During follow-up, 2942 breast cancer deaths occurred (1214 [41.3%] non-Hispanic Black women; 1728 [58.7%] non-Hispanic White women). NDI was associated with an increase in breast cancer mortality (quintile 5 vs 1, HR, 1.36; 95% CI, 1.19-1.55) in Cox proportional hazards models. The association was present only among non-Hispanic White women (quintile 5 vs 1, HR, 1.47; 95% CI, 1.21-1.79). Similar race-specific patterns were observed in jointly stratified analyses, such that NDI was associated with increased breast cancer mortality among non-Hispanic White women, but not non-Hispanic Black women, irrespective of the additional neighborhood characteristics considered.
UNASSIGNED: In this cohort study, neighborhood deprivation was associated with increased breast cancer mortality among non-Hispanic White women. Neighborhood racial composition, residential mobility, and rurality did not explain the lack of association among non-Hispanic Black women, suggesting that factors beyond those explored here may contribute to breast cancer mortality in this racial group.