社区劣势与结直肠癌发病的种族差异：路易斯安那州的一项基于人群的研究。
Neighborhood disadvantage and racial disparities in colorectal cancer incidence: a population-based study in Louisiana.
机构信息
Stanley S. Scott Cancer Center, Louisiana State University Health-New Orleans, School of Medicine, New Orleans, LA.
Stanley S. Scott Cancer Center, Louisiana State University Health-New Orleans, School of Medicine, New Orleans, LA; Department of Epidemiology, Louisiana State University Health-New Orleans, School of Public Health, New Orleans, LA.
出版信息
Ann Epidemiol. 2018 May;28(5):316-321.e2. doi: 10.1016/j.annepidem.2018.02.004. Epub 2018 Mar 22.
PURPOSE
Colorectal cancer (CRC) continues to demonstrate racial disparities in incidence and survival in the United States. This study investigates the role of neighborhood concentrated disadvantage in racial disparities in CRC incidence in Louisiana.
METHODS
Louisiana Tumor Registry and U.S. Census data were used to assess the incidence of CRC diagnosed in individuals 35 years and older between 2008 and 2012. Neighborhood concentrated disadvantage index (CDI) was calculated based on the PhenX Toolkit protocol. The incidence of CRC was modeled using multilevel binomial regression with individuals nested within neighborhoods.
RESULTS
Our study included 10,198 cases of CRC. Adjusting for age and sex, CRC risk was 28% higher for blacks than whites (risk ratio [RR] = 1.28; 95% confidence interval [CI] = 1.22-1.33). One SD increase in CDI was associated with 14% increase in risk for whites (RR = 1.14; 95% CI = 1.10-1.18) and 5% increase for blacks (RR = 1.05; 95% CI = 1.02-1.09). After controlling for differential effects of CDI by race, racial disparities were not observed in disadvantaged areas.
CONCLUSION
CRC incidence increased with neighborhood disadvantage and racial disparities diminished with mounting disadvantage. Our results suggest additional dimensions to racial disparities in CRC outside of neighborhood disadvantage that warrants further research.
目的
在美国，结直肠癌（CRC）的发病率和生存率仍然存在种族差异。本研究调查了邻里集中贫困在路易斯安那州 CRC 发病率种族差异中的作用。
方法
利用路易斯安那州肿瘤登记处和美国人口普查数据，评估了 2008 年至 2012 年间年龄在 35 岁及以上人群中诊断出的 CRC 的发病率。根据 PhenX 工具包协议计算邻里集中贫困指数（CDI）。使用个体嵌套在邻里中的多层次二项式回归模型来模拟 CRC 的发病率。
结果
我们的研究包括 10198 例 CRC 病例。调整年龄和性别后，黑人 CRC 的风险比白人高 28%（风险比 [RR] = 1.28；95%置信区间 [CI] = 1.22-1.33）。CDI 增加一个标准差与白人 CRC 风险增加 14%相关（RR = 1.14；95%CI = 1.10-1.18），与黑人 CRC 风险增加 5%相关（RR = 1.05；95%CI = 1.02-1.09）。在控制 CDI 对不同种族的影响后，在贫困地区没有观察到种族差异。
结论
CRC 的发病率随邻里劣势的增加而增加，而种族差异随着劣势的加剧而减少。我们的结果表明，除了邻里劣势之外，CRC 种族差异存在其他需要进一步研究的维度。
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