Center for Health Disparities, Brody School of Medicine, East Carolina University, 1800 W. 5th Street, Medical Pavilion Suite 6, Greenville, NC, 27858, USA.
Department of Psychiatry and Behavioral Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
J Racial Ethn Health Disparities. 2017 Dec;4(6):1195-1205. doi: 10.1007/s40615-016-0326-9. Epub 2016 Dec 30.
This paper provides the first review of empirical studies of segregation and black-white cancer disparities.
We searched all years of PubMed (through May 2016) using these terms: racial segregation, residential segregation, neighborhood racial composition (first terms) and (second terms) cancer incidence, mortality, survival, stage at diagnosis, screening. The 17 (of 668) articles that measured both segregation and a cancer outcome were retained.
Segregation contributed significantly to cancer and to racial cancer disparities in 70% of analyses, even after controlling for socioeconomic status and health insurance. Residing in segregated African-American areas was associated with higher odds of later-stage diagnosis of breast and lung cancers, higher mortality rates and lower survival rates from breast and lung cancers, and higher cumulative cancer risks associated with exposure to ambient air toxics. There were no studies of many types of cancer (e.g., cervical). Studies differed in their measure of segregation, and 40% used an invalid measure. Possible mediators of the segregation effect usually were not tested.
Empirical analysis of segregation and racial cancer disparities is a recent area of research. The literature is limited to 17 studies that focused primarily on breast cancer. Studies differed in their measure of segregation, yet segregation nonetheless contributed to cancer and to racial cancer disparities in 70% of analyses. This suggests the need for further research that uses valid measures of segregation, examines a variety of types of cancers, and explores the variables that may mediate the segregation effect.
本文是对隔离和黑-白癌症差异的经验研究进行的首次综述。
我们使用以下术语在 PubMed 中搜索所有年份（截至 2016 年 5 月）：种族隔离、居住隔离、邻里种族构成（第一术语）和（第二术语）癌症发病率、死亡率、生存率、诊断时的分期、筛查。保留了 17 篇（668 篇中的）同时测量隔离和癌症结果的文章。
即使在控制社会经济地位和健康保险后，隔离在 70%的分析中对癌症和黑-白癌症差异有显著贡献。居住在隔离的非裔美国人地区与乳腺癌和肺癌晚期诊断、乳腺癌和肺癌死亡率较高、生存率较低以及与接触环境空气毒素相关的累积癌症风险较高有关。没有研究许多类型的癌症（如宫颈癌）。研究在隔离的衡量标准上存在差异，其中 40%使用了无效的衡量标准。隔离影响的可能中介因素通常未经测试。
隔离和黑-白癌症差异的经验分析是一个新的研究领域。文献仅限于 17 项主要关注乳腺癌的研究。研究在隔离的衡量标准上存在差异，但隔离仍然在 70%的分析中对癌症和黑-白癌症差异有贡献。这表明需要进一步研究，使用有效的隔离衡量标准，研究各种类型的癌症，并探讨可能调解隔离影响的变量。
