DeRouen Mindy C, Schupp Clayton W, Koo Jocelyn, Yang Juan, Hertz Andrew, Shariff-Marco Salma, Cockburn Myles, Nelson David O, Ingles Sue A, John Esther M, Gomez Scarlett L
Cancer Prevention Institute of California, Fremont, CA, USA; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA.
Cancer Prevention Institute of California, Fremont, CA, USA.
Cancer Epidemiol. 2018 Apr;53:1-11. doi: 10.1016/j.canep.2018.01.003. Epub 2018 Jan 9.
We addressed the hypothesis that individual-level factors act jointly with social and built environment factors to influence overall survival for men with prostate cancer and contribute to racial/ethnic and socioeconomic (SES) survival disparities.
We analyzed multi-level data, combining (1) individual-level data from the California Collaborative Prostate Cancer Study, a population-based study of non-Hispanic White (NHW), Hispanic, and African American prostate cancer cases (N = 1800) diagnosed from 1997 to 2003, with (2) data on neighborhood SES (nSES) and social and built environment factors from the California Neighborhoods Data System, and (3) data on tumor characteristics, treatment and follow-up through 2009 from the California Cancer Registry. Multivariable, stage-stratified Cox proportional hazards regression models with cluster adjustments were used to assess education and nSES main and joint effects on overall survival, before and after adjustment for social and built environment factors.
African American men had worse survival than NHW men, which was attenuated by nSES. Increased risk of death was associated with residence in lower SES neighborhoods (quintile 1 (lowest nSES) vs. 5: HR = 1.56, 95% CI: 1.11-2.19) and lower education (<high school vs. college: HR = 1.32, 95% CI: 1.05-1.67), and a joint association of low education and low nSES was observed. Adjustment for behavioral, hospital, and restaurant and food environment characteristics only slightly attenuated these associations between SES and survival.
Both individual- and contextual-level SES influence overall survival of men with prostate cancer. Additional research is needed to identify the mechanisms underlying these robust associations.
我们探讨了一个假设，即个体层面的因素与社会和建筑环境因素共同作用，影响前列腺癌男性的总体生存率，并导致种族/族裔和社会经济（SES）生存差异。
我们分析了多层次数据，将（1）来自加利福尼亚前列腺癌协作研究的个体层面数据（一项基于人群的非西班牙裔白人（NHW）、西班牙裔和非裔美国前列腺癌病例研究（N = 1800），这些病例于1997年至2003年被诊断）与（2）来自加利福尼亚邻里数据系统的邻里SES（nSES）以及社会和建筑环境因素数据，以及（3）来自加利福尼亚癌症登记处的截至2009年的肿瘤特征、治疗和随访数据相结合。使用具有聚类调整的多变量、阶段分层Cox比例风险回归模型，在调整社会和建筑环境因素之前和之后，评估教育和nSES对总体生存的主要和联合效应。
非裔美国男性的生存率低于NHW男性，nSES减弱了这种差异。死亡风险增加与居住在较低SES社区（五分位数1（最低nSES）与五分位数5相比：风险比（HR）= 1.56，95%置信区间（CI）：1.11 - 2.19）以及较低教育水平（高中以下与大学相比：HR = 1.32，95% CI：1.05 - 1.67）相关，并且观察到低教育水平和低nSES之间存在联合关联。对行为、医院以及餐厅和食物环境特征进行调整后，SES与生存之间的这些关联仅略有减弱。
个体层面和背景层面的SES均影响前列腺癌男性的总体生存。需要进一步研究以确定这些强关联背后的机制。
