Bradley Cathy J, Given Charles W, Roberts Caralee
Department of Medicine, Michigan State University, East Lansing 48824, USA.
J Natl Cancer Inst. 2002 Apr 3;94(7):490-6. doi: 10.1093/jnci/94.7.490.
Previous studies have found that African-American women are more likely than white women to have late-stage breast cancer at diagnosis and shortened survival. However, there is considerable controversy as to whether these differences in diagnosis and survival are attributable to race or socioeconomic status. Our goal was to disentangle the influence of race and socioeconomic status on breast cancer stage, treatment, and survival.
We linked data from the Metropolitan Detroit Surveillance, Epidemiology, and End Results (SEER)(1) registry to Michigan Medicaid enrollment files and identified 5719 women diagnosed with breast cancer, of whom 593 were insured by Medicaid. We first calculated the unadjusted odds ratios (ORs) associated with race, Medicaid insurance, and poverty for breast cancer stage at diagnosis, breast cancer treatment, and death. We then estimated the ORs of having late-stage breast cancer at diagnosis, breast-conserving surgery, no surgery, and death using logistic regression after controlling for clinical and nonclinical factors. All statistical tests were two-sided.
Before controlling for Medicaid enrollment and poverty, African-American women had a higher likelihood than white women of each unfavorable breast cancer outcome. However, after controlling for covariates, African-American women were not statistically significantly different from white women on most outcomes except for surgical choice. African-American women were more likely than white women to have no surgery (adjusted OR = 1.62; 95% confidence interval [CI] = 1.11 to 2.37). Among women who had surgery, African-American women were more likely to have breast-conserving surgery than were white women (adjusted OR = 1.63; 95% CI = 1.33 to 1.98).
The linkage of Medicaid and SEER data provides more in-depth information on low-income women than has been available in past studies. In our Metropolitan Detroit study population, race was not statistically significantly associated with unfavorable breast cancer outcomes. However, low socioeconomic status was associated with late-stage breast cancer at diagnosis, type of treatment received, and death.
先前的研究发现，非裔美国女性在确诊时患晚期乳腺癌的可能性比白人女性更高，且生存期较短。然而，关于这些诊断和生存差异是归因于种族还是社会经济地位，存在相当大的争议。我们的目标是厘清种族和社会经济地位对乳腺癌分期、治疗及生存的影响。
我们将底特律大都市监测、流行病学和最终结果（SEER）登记处的数据与密歇根医疗补助登记文件相链接，识别出5719名被诊断为乳腺癌的女性，其中593人有医疗补助保险。我们首先计算了与种族、医疗补助保险及贫困相关的未调整比值比（OR），用于诊断时的乳腺癌分期、乳腺癌治疗及死亡情况。然后，在控制临床和非临床因素后，使用逻辑回归估计诊断时患晚期乳腺癌、保乳手术、未手术及死亡的OR。所有统计检验均为双侧检验。
在控制医疗补助登记和贫困因素之前，非裔美国女性在每种不良乳腺癌结局方面比白人女性的可能性更高。然而，在控制协变量后，除手术选择外，非裔美国女性在大多数结局方面与白人女性在统计学上无显著差异。非裔美国女性比白人女性更有可能不接受手术（调整后的OR = 1.62；95%置信区间[CI] = 1.11至2.37）。在接受手术的女性中，非裔美国女性比白人女性更有可能接受保乳手术（调整后的OR = 1.63；95%CI = 1.33至1.98）。
医疗补助和SEER数据的链接为低收入女性提供了比以往研究更深入的信息。在我们底特律大都市的研究人群中，种族与不良乳腺癌结局在统计学上无显著关联。然而，社会经济地位较低与诊断时的晚期乳腺癌、接受的治疗类型及死亡相关。
