Rauscher Garth H, Dabbous Firas, Dolecek Therese A, Friedewald Sarah M, Tossas-Milligan Katherine, Macarol Teresita, Summerfelt W Thomas
Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago.
James R. & Helen D. Russell Institute for Research & Innovation, Advocate Lutheran General Hospital - Center for Advanced Care, Advocate Health Care, Oak Brook, IL.
Ann Epidemiol. 2017 Oct;27(10):654-658. doi: 10.1016/j.annepidem.2017.09.002. Epub 2017 Sep 20.
Compared to non-Latina (nL) white women, nL black women are diagnosed with more aggressive breast cancers, which in turn should be more likely to go undetected on screening mammography and subsequently arise as interval breast cancer (IBC). We sought to estimate the extent of an anticipated racial disparity in IBC within a single, large health care organization.
The present analysis focuses on 4357 breast cancers diagnosed between 2001 and 2012 and within 18 months of a screening mammogram (N = 714,218). We used logistic regression with model-based standardization (predictive margins) to estimate adjusted prevalence differences corresponding to a racial disparity in IBC.
Overall, prevalence of IBC within 18 months was 20.7%. Contrary to expectation, in patient-adjusted models, there was no IBC racial disparity (percentage point disparity = -2.1, 95% confidence interval: -4.7, 2.6). However, when controlling for facility characteristics, including proportion of nL black patients, the model coefficient for the IBC disparity reversed sign and changed substantially (P < .0001) and a racial disparity emerged (percentage point disparity = +5.1, 95% confidence interval: -0.3, 9.9).
The sorting of patients by race across facilities appears to have mitigated an otherwise anticipated disparity in IBC. Possible explanations are discussed.
与非拉丁裔（nL）白人女性相比，nL黑人女性被诊断出患有侵袭性更强的乳腺癌，这反过来应该更有可能在乳腺钼靶筛查中未被发现，并随后发展为间期乳腺癌（IBC）。我们试图估计在一个大型医疗保健机构中IBC预期种族差异的程度。
本分析聚焦于2001年至2012年间诊断出的4357例乳腺癌，且这些乳腺癌是在乳腺钼靶筛查后18个月内确诊的（N = 714,218）。我们使用基于模型标准化（预测边际）的逻辑回归来估计与IBC种族差异相对应的调整患病率差异。
总体而言，18个月内IBC的患病率为20.7%。与预期相反，在患者调整模型中，不存在IBC种族差异（百分点差异 = -2.1，95%置信区间：-4.7，2.6）。然而，在控制设施特征（包括nL黑人患者比例）后，IBC差异的模型系数符号反转且变化很大（P <.0001），出现了种族差异（百分点差异 = +5.1，95%置信区间：-0.3，9.9）。
按种族在各机构间对患者进行分类似乎减轻了IBC原本预期的差异。讨论了可能的解释。
