■关于种族/种族主义及其与社会经济地位(SES)对乳腺癌和宫颈癌的影响的证据有限,全球最常见的两种女性癌症。我们调查了乳腺癌和宫颈癌死亡率中的种族不平等,以及SES(教育和家庭状况)是否与种族/民族相互作用。
■1亿巴西队列数据与巴西死亡率数据库相关联,2004-2015年(n=20,665,005名成年女性)。我们使用泊松回归分析了自我报告的种族/民族(白人/“帕达”(布朗)/黑人/亚洲/土著)与癌症死亡率之间的关系,调整年龄,日历年,教育,家庭条件和居住面积。评估了加性和乘法相互作用。
■土著宫颈癌死亡率较高(调整后死亡率=1.80,95CI1.39-2.33),亚洲(1.63,1.20-2.22),\'Parda\'(布朗)(1.27,1.21-1.33)和黑人(1.18,1.09-1.28)女性与白人女性。与白人女性相比,黑人女性的乳腺癌死亡率更高(1.10,1.04-1.17)。在家庭条件较差的妇女中,宫颈癌死亡率的种族不平等现象更大,和低教育(乘法交互的P分别<0.001和0.02)。与生活在完全适当(3-4)家庭条件下的白人妇女相比,3-4,1-2和没有适当条件的黑人妇女的宫颈癌死亡风险为1.10(1.01-1.21),1.48(1.28-1.71),和2.03(1.56-2.63),分别(由于相互作用-RERI=0.78,0.18-1.38导致的相对超额风险)。在“Parda”(布朗)女性中,风险为1.18(1.11-1.25),1.68(1.56-1.81),和1.84(1.63-2.08),分别(RERI=0.52,0.16-0.87)。与受过高等教育的白人女性相比,风险很高,中低学历黑人女性为1.14(0.83-1.55),1.93(1.57-2.38)和2.75(2.33-3.25),分别(RERI=0.36,-0.05-0.77)。在“Parda”(布朗)女性中,风险为1.09(0.91-1.31),1.99(1.70-2.33)和3.03(2.61-3.52),分别(RERI=0.68,0.48-0.88)。没有发现乳腺癌的相互作用。
■低SES放大了子宫颈癌死亡率的种族不平等。种族/民族之间的交集,需要解决SES和性别问题,以减少种族健康不平等。
UNASSIGNED: There is limited evidence regarding the impact of race/racism and its intersection with socioeconomic status (SES) on breast and cervical cancer, the two most common female cancers globally. We investigated racial inequalities in breast and cervical cancer mortality and whether SES (education and household conditions) interacted with race/ethnicity.
UNASSIGNED: The 100 Million Brazilian Cohort data were linked to the Brazilian Mortality Database, 2004-2015 (n = 20,665,005 adult women). We analysed the association between self-reported race/ethnicity (White/\'Parda\'(Brown)/Black/Asian/Indigenous) and cancer mortality using Poisson regression, adjusting for age, calendar year, education, household conditions and area of residence. Additive and multiplicative interactions were assessed.
UNASSIGNED: Cervical cancer mortality rates were higher among Indigenous (adjusted Mortality rate ratio = 1.80, 95%CI 1.39-2.33), Asian (1.63, 1.20-2.22), \'Parda\'(Brown) (1.27, 1.21-1.33) and Black (1.18, 1.09-1.28) women vs White women. Breast cancer mortality rates were higher among Black (1.10, 1.04-1.17) vs White women. Racial inequalities in cervical cancer mortality were larger among women of poor household conditions, and low education (P for multiplicative interaction <0.001, and 0.02, respectively). Compared to White women living in completely adequate (3-4) household conditions, the risk of cervical cancer mortality in Black women with 3-4, 1-2, and none adequate conditions was 1.10 (1.01-1.21), 1.48 (1.28-1.71), and 2.03 (1.56-2.63), respectively (Relative excess risk due to interaction-RERI = 0.78, 0.18-1.38). Among \'Parda\'(Brown) women the risk was 1.18 (1.11-1.25), 1.68 (1.56-1.81), and 1.84 (1.63-2.08), respectively (RERI = 0.52, 0.16-0.87). Compared to high-educated White women, the risk in high-, middle- and low-educated Black women was 1.14 (0.83-1.55), 1.93 (1.57-2.38) and 2.75 (2.33-3.25), respectively (RERI = 0.36, -0.05-0.77). Among \'Parda\'(Brown) women the risk was 1.09 (0.91-1.31), 1.99 (1.70-2.33) and 3.03 (2.61-3.52), respectively (RERI = 0.68, 0.48-0.88). No interactions were found for breast cancer.
UNASSIGNED: Low SES magnified racial inequalities in cervical cancer mortality. The intersection between race/ethnicity, SES and gender needs to be addressed to reduce racial health inequalities.