Izano Monika, Satariano William A, Tammemagi Martin C, Ragland David, Moore Dan H, Allen Elaine, Naeim Arash, Sehl Mary E, Hiatt Robert A, Kerlikowske Karla, Sofrygin Oleg, Braithwaite Dejana
Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
School of Public Health, University of California, Berkeley, CA, USA.
J Geriatr Oncol. 2014 Jul;5(3):266-75. doi: 10.1016/j.jgo.2014.02.003. Epub 2014 Mar 5.
We examined the association between comorbidity and long-term mortality from breast cancer and other causes among African-American and white women with breast cancer.
A total of 170 African-American and 829 white women aged 40-84years were followed for up to 28years with median follow-up of 11.3years in the Health and Functioning in Women (HFW) study. The impact of the Charlson Comorbidity Score (CCS) in the first few months following breast cancer diagnosis on the risk of mortality from breast cancer and other causes was examined using extended Cox models.
Median follow-up was significantly shorter for African-American women than their white counterparts (median 8.5years vs. 12.3years). Compared to white women, African-American women had significantly fewer years of education, greater body mass index, were more likely to have functional limitations and later stage at breast cancer diagnosis, and fewer had adequate financial resources (all P<0.05). Proportionately more African-American women died of breast cancer than white women (37.1% vs. 31.4%, P=0.15). A positive and statistically significant time-varying effect of the Charlson Comorbidity Score (CCS) on other-cause mortality persisted throughout the first 5years of follow-up (P<0.001) but not for its remainder.
Higher CCS was associated with increased risk of other-cause mortality, but not breast cancer specific mortality; the association did not differ among African-American and white women.
我们研究了合并症与非裔美国和白人乳腺癌女性患者因乳腺癌及其他原因导致的长期死亡率之间的关联。
在“女性健康与功能”（HFW）研究中，对170名年龄在40 - 84岁的非裔美国女性和829名白人女性进行了长达28年的随访，中位随访时间为11.3年。使用扩展Cox模型检查了乳腺癌诊断后头几个月的Charlson合并症评分（CCS）对乳腺癌及其他原因导致的死亡风险的影响。
非裔美国女性的中位随访时间明显短于白人女性（中位8.5年对12.3年）。与白人女性相比，非裔美国女性受教育年限明显更少，体重指数更高，更有可能存在功能受限，乳腺癌诊断时分期更晚，且拥有足够经济资源的人更少（所有P<0.05）。死于乳腺癌的非裔美国女性比例高于白人女性（37.1%对31.4%，P = 0.15）。Charlson合并症评分（CCS）对其他原因导致的死亡率在随访的前5年中始终存在正向且具有统计学意义的时间变化效应（P<0.001），但在其余时间则不存在。
较高的CCS与其他原因导致的死亡风险增加相关，但与乳腺癌特异性死亡率无关；这种关联在非裔美国女性和白人女性中没有差异。
