Department of Behavioral Sciences and Health Education, Rollins School of Public Health of Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA.
Cancer Causes Control. 2012 Sep;23(9):1519-27. doi: 10.1007/s10552-012-0029-4. Epub 2012 Jul 24.
There are significant relationships between racial residential segregation (RRS) and a range of health outcomes, including cancer-related outcomes. This study explores the contribution of metropolitan area RRS, census tract racial composition and breast cancer and all-cause mortality among black and white breast cancer patients.
This study has three units of analysis: women diagnosed with breast cancer (n = 22,088), census tracts where they lived at diagnosis (n = 1,373), and the metropolitan statistical area (MSA)/micropolitan statistical area (MiSA) where they lived at diagnosis (n = 37). Neighborhood racial composition was measured as the percent of black residents in the census tract. Metropolitan area RRS was measured using the Information Theory Index. Multilevel Cox proportional hazards models examined the association of metropolitan area RRS and census tract racial composition with breast cancer and all-cause mortality. Survival analysis explored and compared the risk of death in women exposed to environments where a higher and lower proportion of residents were black.
Breast cancer mortality disparities were largest in racially mixed tracts located in high MSA/MiSA segregation areas (RR = 2.06, 95 % CI 1.70, 2.50). For black but not white women, as MSA/MiSA RRS increased, there was an increased risk for breast cancer mortality (HR = 2.20, 95 % CI 1.09, 4.45). For all-cause mortality, MSA/MiSA segregation was not a significant predictor, but increasing tract percent black was associated with increased risk for white but not black women (HR 1.29, 95 % CI 1.05, 1.58).
Racial residential segregation may influence health for blacks and whites differently. Pathways through which RRS patterns impact health should be further explored.
族裔居住隔离（RRS）与一系列健康结果之间存在显著关系，包括与癌症相关的结果。本研究探讨了大都市地区 RRS、普查区种族构成以及黑人和白人乳腺癌患者的乳腺癌和全因死亡率之间的关系。
本研究有三个分析单位：被诊断患有乳腺癌的女性（n=22088）、她们在诊断时居住的普查区（n=1373）以及她们在诊断时居住的大都市区/都会统计区（MSA）/密尔沃基统计区（MiSA）（n=37）。邻里种族构成以普查区黑人居民的百分比衡量。大都市地区 RRS 用信息理论指数衡量。多水平 Cox 比例风险模型检查大都市地区 RRS 和普查区种族构成与乳腺癌和全因死亡率之间的关联。生存分析探讨并比较了暴露于居民黑人比例较高和较低环境中的女性死亡风险。
在种族混合的普查区，乳腺癌死亡率差异最大，这些普查区位于高度隔离的大都市/密尔沃基统计区（RR=2.06，95%CI 1.70，2.50）。对于黑人女性，但不是白人女性，随着 MSA/MiSA RRS 的增加，乳腺癌死亡率的风险增加（HR=2.20，95%CI 1.09，4.45）。对于全因死亡率，MSA/MiSA 隔离不是一个显著的预测因素，但普查区黑人比例的增加与白人女性而不是黑人女性的风险增加相关（HR 1.29，95%CI 1.05，1.58）。
族裔居住隔离可能会对黑人和白人的健康产生不同的影响。应进一步探讨 RRS 模式影响健康的途径。
