Centre for Public Health Research, Massey University, Wellington, New Zealand.
Epidemiol Rev. 2009;31:52-66. doi: 10.1093/epirev/mxp007. Epub 2009 Aug 12.
Despite numerous studies documenting ethnic inequalities in breast cancer survival between minority and majority ethnic groups worldwide, reasons for these inequalities remain unclear. The authors performed a systematic review of published literature to identify studies that investigated the explanatory power of smoking, alcohol consumption, body mass index (BMI), and socioeconomic position (SEP) on ethnic inequalities in breast cancer survival. Sixteen studies were included in the review. From 5 studies, the authors found that differences in breast cancer survival between ethnic groups may be in part explained by BMI, but there was little evidence to implicate smoking or alcohol consumption as explanatory factors of this inequality. From 12 studies, the authors found that SEP explains part of the ethnic inequality in all-cause survival but that it was not evident for breast-cancer-specific survival. SEP explains more of the disparities among African-American versus white women in the United States compared with other ethnic comparisons. Furthermore, given social patterning of BMI and other lifestyle habits, it is possible that results for SEP and BMI are measuring the same effect. In this review, the authors make suggestions regarding the role of epidemiology in facilitating further research to better inform the development of effective policies to address ethnic differences in survival.
尽管有大量研究记录了全球少数族裔和多数族裔群体之间乳腺癌生存的种族不平等现象，但这些不平等现象的原因仍不清楚。作者对已发表的文献进行了系统综述，以确定研究吸烟、饮酒、体重指数（BMI）和社会经济地位（SEP）对乳腺癌生存种族不平等的解释能力的研究。该综述共纳入了 16 项研究。其中 5 项研究发现，不同种族之间乳腺癌生存率的差异部分可能可以用 BMI 来解释，但几乎没有证据表明吸烟或饮酒是导致这种不平等的因素。12 项研究发现，SEP 可以解释部分全因生存率的种族不平等，但对乳腺癌特异性生存率的解释作用并不明显。SEP 可以更好地解释美国非裔美国女性与白人女性之间的差异，而不是其他族裔之间的差异。此外，鉴于 BMI 和其他生活方式习惯的社会分布，SEP 和 BMI 的结果可能在衡量相同的影响。在本次综述中，作者就流行病学在促进进一步研究以更好地为制定解决生存差异的有效政策提供信息方面的作用提出了建议。
