作者确定了肿瘤,治疗,和可能导致不同种族乳腺癌(BC)死亡率差异的患者特征,rurality,和地区层面的社会经济地位(SES)的妇女诊断为IIIB-IVBC在格鲁吉亚。
使用佐治亚州癌症登记处,确定了3084例IIIB-IV期原发性BC(2013-2017)患者。Cox比例风险回归用于计算非西班牙裔黑人(NHB)与非西班牙裔白人(NHW)死亡率的风险比(HR)和95%置信区间(CI)。农村和城市社区的居民,和低SES和高SES社区的居民,治疗,和患者特征。估计了特定特征对种族与BC死亡率之间关系的中介作用。
在研究人群中,41%是NHB,21%居住在农村县,和72%居住在低SES社区。作者观察到按种族划分的死亡率差异(HR,1.27;95%CI,1.13,1.41)和农村(HR,1.14;95%CI,1.00,1.30),但不是由SES(HR,1.04;95%CI,0.91,1.19)。在分层分析中,种族差异在HER2过表达肿瘤的女性中最为明显(HR,2.30;95%CI,1.53,3.45)。居住在农村县与未参保妇女死亡率增加有关(人力资源,2.25;95%CI,1.31,3.86),最明显的SES差异是年轻女性(<40岁:HR,1.46;95%CI,0.88,2.42)。
种族差异很大,区域,以及肿瘤导致的晚期BC死亡率的社会经济差异,治疗,和患者特征。
The authors identified tumor, treatment, and patient characteristics that may contribute to differences in breast cancer (BC) mortality by race, rurality, and area-level socioeconomic status (SES) among women diagnosed with stage IIIB-IV BC in Georgia.
Using the Georgia Cancer Registry, 3084 patients with stage IIIB-IV primary BC (2013-2017) were identified. Cox proportional hazards regression was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) comparing mortality among non-Hispanic Black (NHB) versus non-Hispanic White (NHW), residents of rural versus urban neighborhoods, and residents of low- versus high-SES neighborhoods by tumor, treatment, and patient characteristics. The mediating effects of specific characteristics on the association between race and BC mortality were estimated.
Among the study population, 41% were NHB, 21% resided in rural counties, and 72% resided in low SES neighborhoods. The authors observed mortality disparities by race (HR, 1.27; 95% CI, 1.13, 1.41) and rurality (HR, 1.14; 95% CI, 1.00, 1.30), but not by SES (HR, 1.04; 95% CI, 0.91, 1.19). In the stratified analyses, racial disparities were the most pronounced among women with HER2 overexpressing tumors (HR, 2.30; 95% CI, 1.53, 3.45). Residing in a rural county was associated with increased mortality among uninsured women (HR, 2.25; 95% CI, 1.31, 3.86), and the most pronounced SES disparities were among younger women (<40 years: HR, 1.46; 95% CI, 0.88, 2.42).
There is considerable variation in racial, regional, and socioeconomic disparities in late-stage BC mortality by tumor, treatment, and patient characteristics.