Hossain Fokhrul, Danos Denise, Prakash Om, Gilliland Aubrey, Ferguson Tekeda F, Simonsen Neal, Leonardi Claudia, Yu Qingzhao, Wu Xiao-Cheng, Miele Lucio, Scribner Richard
School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, United States.
School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States.
Front Public Health. 2019 Feb 18;7:18. doi: 10.3389/fpubh.2019.00018. eCollection 2019.
Triple Negative Breast Cancer (TNBC) is an aggressive, heterogeneous subtype of breast cancer, which is more frequently diagnosed in African American (AA) women than in European American (EA) women. The purpose of this study is to investigate the role of social determinants in racial disparities in TNBC. Data on Louisiana TNBC patients diagnosed in 2010-2012 were collected and geocoded to census tract of residence at diagnosis by the Louisiana Tumor Registry. Using multilevel statistical models, we analyzed the role of neighborhood concentrated disadvantage index (CDI), a robust measure of physical and social environment, in racial disparities in TNBC incidence, stage at diagnosis, and stage-specific survival for the study population. Controlling for age, we found that AA women had a 2.21 times the incidence of TNBC incidence compared to EA women. Interestingly, the incidence of TNBC was independent of neighborhood CDI and adjusting for neighborhood environment did not impact the observed racial disparity. AA women were more likely to be diagnosed at later stages and CDI was associated with more advanced stages of TNBC at diagnosis. CDI was also significantly associated with poorer stage-specific survival. Overall, our results suggest that neighborhood disadvantage contributes to racial disparities in stage at diagnosis and survival among TNBC patients, but not to disparities in incidence of the disease. Further research is needed to determine the mechanisms through which social determinants affect the promotion and progression of this disease and guide efforts to improve overall survival.
三阴性乳腺癌（TNBC）是一种侵袭性、异质性的乳腺癌亚型，非裔美国（AA）女性比欧裔美国（EA）女性更常被诊断出患有这种疾病。本研究的目的是调查社会决定因素在TNBC种族差异中的作用。收集了2010 - 2012年在路易斯安那州被诊断为TNBC患者的数据，并通过路易斯安那肿瘤登记处将其地理编码到诊断时居住的普查区。使用多水平统计模型，我们分析了邻里集中劣势指数（CDI）这一衡量物理和社会环境的有力指标在研究人群TNBC发病率、诊断分期及特定分期生存率的种族差异中的作用。在控制年龄后，我们发现与EA女性相比，AA女性患TNBC的发病率是其2.21倍。有趣的是，TNBC的发病率与邻里CDI无关，调整邻里环境也不会影响观察到的种族差异。AA女性更有可能在较晚阶段被诊断出来，并且CDI与TNBC诊断时更晚期的阶段相关。CDI也与较差的特定分期生存率显著相关。总体而言，我们的结果表明，邻里劣势导致了TNBC患者在诊断分期和生存率方面的种族差异，但不是该疾病发病率的差异。需要进一步研究以确定社会决定因素影响这种疾病的促进和进展的机制，并指导改善总体生存率的努力。
