Department of Behavioral Sciences and Health Education, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA.
J Urban Health. 2011 Dec;88(6):1117-29. doi: 10.1007/s11524-011-9612-3.
We explored the association between neighborhood residential racial composition and breast cancer mortality among Black and White breast cancer patients in Georgia and whether spatial access to cancer care mediates this association. Participants included 15,256 women living in 15 metropolitan statistical areas in Georgia who were diagnosed with breast cancer between 1999 and 2003. Residential racial composition was operationalized as the percent of Black residents in the census tract. We used gravity-based modeling methods to ascertain spatial access to oncology care. Multilevel Cox proportional hazards models and mediation analyses were used to test associations. Black women were 1.5 times more likely to die from breast cancer than White women. Residential racial composition had a small but significant association with breast cancer mortality (hazard ratios [HRs] = 1.04-1.08 per 10% increase in the percent of Black tract residents). Individual race did not moderate this relationship, and spatial access to care did not mediate it. Residential racial composition may be part of the socioenvironmental milieu that produces increased breast cancer mortality among Black women. However, there is a lack of evidence that spatial access to oncology care mediates these processes.
我们探讨了佐治亚州黑人和白人乳腺癌患者的社区居住种族构成与乳腺癌死亡率之间的关系，以及癌症护理的空间可达性是否调节了这种关系。参与者包括 1999 年至 2003 年间在佐治亚州 15 个大都市区诊断出患有乳腺癌的 15256 名女性。居住种族构成以普查区的黑人居民百分比来表示。我们使用基于重力的建模方法来确定肿瘤学护理的空间可达性。多水平 Cox 比例风险模型和中介分析用于检验关联。黑人女性死于乳腺癌的可能性比白人女性高 1.5 倍。居住种族构成与乳腺癌死亡率呈弱相关（每 10%黑人居民比例增加，风险比[HR]为 1.04-1.08）。个体种族并不能调节这种关系，而癌症护理的空间可达性也不能调节这种关系。居住种族构成可能是导致黑人女性乳腺癌死亡率增加的社会环境的一部分。然而，没有证据表明肿瘤学护理的空间可达性调节了这些过程。
