目的：乳腺癌生存率的差异仍然是一个挑战。我们旨在分析结构性种族主义的影响，以极端浓度指数(ICE)衡量，在收到国家癌症中心网络（NCCN）指南一致的乳腺癌治疗。
方法：我们确定了2005年至2017年在两个机构接受治疗的I-IV期乳腺癌患者。人口普查区充当邻里代理。使用美国社区调查的5年估计，计算了5个ICE变量，创建了5个模型，控制经济隔离，非西班牙裔黑人（NHB）隔离，NHB/经济隔离，西班牙裔隔离，和西班牙裔/经济隔离。在接受NCCN指南一致的乳腺癌治疗后，使用多水平逻辑回归模型来确定个体和邻里水平特征之间的关联。
结果：包括5173例患者：55.2％为西班牙裔，NHW占27.5%，17.3%是NHB。无论经济隔离还是居住隔离，1例NHB患者接受适当治疗的可能性较小[(OR)Model10.58(0.45-0.74);ORModel20.59(0.46-0.78);ORModel30.62(0.47-0.81);ORModel40.53(0.40-0.69);ORModel50.59(0.46-0.76);p<0.05].
结论：据我们所知，这是评估ICE接受NCCN指南一致治疗的第一个分析，结构性种族主义的有效措施。虽然许多文献强调邻里层面的治疗障碍，我们的结果表明，与NHW患者相比，NHB患者不太可能接受NCCN指南一致的乳腺癌治疗，独立于经济或居住隔离。我们的研究表明，在获得经济或居住隔离之外的适当护理方面，存在潜在的下落不明的个人或社区障碍。
OBJECTIVE: Disparities in breast cancer survival remain a challenge. We aimed to analyze the effect of structural racism, as measured by the Index of Concentration at the Extremes (ICE), on receipt of National Cancer Center Network (NCCN)
guideline-concordant breast cancer treatment.
METHODS: We identified patients treated at two institutions from 2005 to 2017 with stage I-IV breast cancer. Census tracts served as neighborhood proxies. Using 5-year estimates from the American Community Survey, 5 ICE variables were computed to create 5 models, controlling for economic segregation, non-Hispanic Black (NHB)
segregation, NHB/economic
segregation, Hispanic
segregation, and Hispanic/economic
segregation. Multi-level logistic regression models were used to determine the association between individual and neighborhood-level characteristics on receipt of NCCN guideline-concordant breast cancer treatment.
RESULTS: 5173 patients were included: 55.2% were Hispanic, 27.5% were NHW, and 17.3% were NHB. Regardless of economic or residential segregation, a NHB patient was less likely to receive appropriate treatment [(OR)Model1 0.58 (0.45-0.74); ORModel2 0.59 (0.46-0.78); ORModel3 0.62 (0.47-0.81); ORModel4 0.53 (0.40-0.69); ORModel5 0.59(0.46-0.76); p < 0.05].
CONCLUSIONS: To our knowledge, this is the first analysis assessing receipt of NCCN
guideline-concordant treatment by ICE, a validated measure for structural racism. While much literature emphasizes neighborhood-level barriers to treatment, our results demonstrate that compared to NHW patients, NHB patients are less likely to receive NCCN
guideline-concordant breast cancer treatment, independent of economic or residential segregation. Our study suggests that there are potential unaccounted individual or neighborhood barriers to receipt of appropriate care that go beyond economic or residential segregation.
