萨克拉门托地区乳腺癌流行病学研究：农村到城市连续体中乳腺癌根治术后乳房重建的应用。
Sacramento area breast cancer epidemiology study: use of postmastectomy breast reconstruction along the rural-to-urban continuum.
机构信息
Sacramento, Calif. From the Department of Surgery, Division of Surgical Oncology, and the Division of Plastic and Reconstructive Surgery, University of California, Davis.
出版信息
Plast Reconstr Surg. 2010 Dec;126(6):1815-1824. doi: 10.1097/PRS.0b013e3181f444bc.
BACKGROUND
Health care disparities have been documented in rural populations. The authors hypothesized that breast cancer patients in urban counties would have higher rates of postmastectomy breast reconstruction relative to patients in surrounding near-metro and rural counties.
METHODS
The authors used the Surveillance, Epidemiology, and End Results database to identify patients diagnosed with breast cancer and treated with mastectomy in the greater Sacramento area between 2000 and 2006. Counties were categorized as urban, near-metro, or rural. Univariate models evaluated the relationship of rural, near-metro, or urban location with use of breast reconstruction by means of the chi-square test. Multivariate logistic regression models controlling for patient, tumor, and treatment-related factors predicted use of breast reconstruction. The likelihood of undergoing breast reconstruction was reported as odds ratios with 95 percent confidence intervals; significance was set at p≤0.05.
RESULTS
Complete information was available for 3552 breast cancer patients treated with mastectomy. Of these, 718 (20.2 percent) underwent breast reconstruction. On univariate analysis, differences in the rates of breast reconstruction were noted among urban, near-metro, and rural areas (p<0.001). On multivariate analysis, patients from rural (odds ratio, 0.51; 95 percent confidence interval, 0.28 to 0.93; p<0.03) and near-metro (odds ratio, 0.73; 95 percent confidence interval, 0.59 to 0.89; p=0.002) areas had a decreased likelihood of undergoing breast reconstruction relative to patients from urban areas.
CONCLUSIONS
Patients from near-metro and rural areas are less likely to undergo breast reconstruction following mastectomy for breast cancer than their urban counterparts. Differences in use of breast reconstruction detected at a population level should guide future interventions to increase rates of breast reconstruction at the local level.
背景
农村人口的医疗保健差距已得到记录。作者假设，与周边近都市区和农村县的患者相比，城市县的乳腺癌患者在接受乳房切除术（mastectomy）后进行乳房重建的比例会更高。
方法
作者使用监测、流行病学和最终结果数据库（Surveillance, Epidemiology, and End Results database），确定了 2000 年至 2006 年期间在萨克拉门托大都市区接受过乳房切除术（mastectomy）治疗的乳腺癌患者。将各县归类为城市、近都市区或农村。单变量模型通过卡方检验（chi-square test）评估农村、近都市区或城市位置与乳房重建使用之间的关系。多变量逻辑回归模型通过控制患者、肿瘤和治疗相关因素，预测了乳房重建的使用。通过 95%置信区间的比值比（odds ratio）报告了接受乳房重建的可能性；p 值≤0.05 为具有统计学意义。
结果
在接受乳房切除术（mastectomy）治疗的 3552 例乳腺癌患者中，有完整信息的患者为 3552 例。其中，718 例（20.2%）接受了乳房重建。在单变量分析中，城市、近都市区和农村地区的乳房重建率存在差异（p<0.001）。在多变量分析中，与来自城市地区的患者相比，来自农村（比值比，0.51；95%置信区间，0.28 至 0.93；p<0.03）和近都市区（比值比，0.73；95%置信区间，0.59 至 0.89；p=0.002）地区的患者进行乳房重建的可能性较低。
结论
与城市地区的患者相比，来自近都市区和农村地区的患者在接受乳腺癌乳房切除术（mastectomy）后进行乳房重建的可能性较小。在人群水平上检测到的乳房重建使用差异应指导未来的干预措施，以提高当地水平的乳房重建率。
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