College of Nursing, University of South Carolina, Columbia, SC, USA.
Cancer. 2012 May 15;118(10):2693-9. doi: 10.1002/cncr.26570. Epub 2011 Sep 27.
Although much has been done to examine those factors associated with higher mortality among African American women, there is a paucity of literature that examines disparities among rural African Americans in South Carolina. The purpose of this investigation was to examine the association of race and mortality among breast cancer patients in a large cohort residing in South Carolina for which treatment regimens are standardized for all patients.
Subjects included 1209 women diagnosed with breast cancer between 2000 and 2002 at a large, local hospital containing a comprehensive breast center. Kaplan-Meier survival curves were calculated to determine survival rates among African American and European American women, stratified by disease stage or other prognostic characteristics. Adjusting for various characteristics, Cox multivariate survival models were used to estimate the hazard ratio (HR).
The 5-year overall all-cause mortality survival proportion was ∼78% for African American women and ∼89% for European American women, P < 0.01. In analyses of subpopulations of women with identical disease characteristics, African American women had significantly higher mortality than European American women for the same type of breast cancer disease. In multivariate models, African American women had significantly higher mortality than European American women for both breast cancer-specific death (HR, 2.41; 95% confidence interval [CI], 1.21-4.79) and all-cause mortality (HR, 1.42; 95% CI, 1.06-1.89).
African American women residing in rural South Carolina had lower survival for breast cancer even after adjustment for disease-related prognostic characteristics. These findings support health interventions among African American breast cancer patients aimed at tertiary prevention strategies or further down-staging of disease at diagnosis.
尽管已经做了很多工作来研究与非裔美国女性死亡率较高相关的因素，但关于南卡罗来纳州农村非裔美国人之间差异的文献却很少。本研究的目的是检查种族和死亡率之间的关联在一个大型队列中的乳腺癌患者居住在南卡罗来纳州的治疗方案为所有患者标准化。
研究对象包括 1209 名在一家大型当地医院被诊断患有乳腺癌的女性，该医院设有综合乳房中心，诊断时间为 2000 年至 2002 年。通过 Kaplan-Meier 生存曲线计算来确定非洲裔美国人和欧洲裔美国女性之间的生存率，按疾病分期或其他预后特征分层。在调整了各种特征后，使用 Cox 多变量生存模型来估计危险比（HR）。
非洲裔美国女性的 5 年总全因死亡率生存比例约为 78%，而欧洲裔美国女性的比例约为 89%，P<0.01。在对具有相同疾病特征的女性亚群的分析中，患有相同类型乳腺癌疾病的非洲裔美国女性的死亡率明显高于欧洲裔美国女性。在多变量模型中，非洲裔美国女性的乳腺癌特异性死亡（HR，2.41；95%置信区间[CI]，1.21-4.79）和全因死亡率（HR，1.42；95%CI，1.06-1.89）均明显高于欧洲裔美国女性。
即使在调整了与疾病相关的预后特征后，居住在南卡罗来纳州农村的非裔美国女性的乳腺癌生存率仍然较低。这些发现支持针对非裔美国乳腺癌患者的健康干预措施，旨在采取三级预防策略或进一步降低诊断时的疾病分期。
