Roberson Patricia N E, Miller Melanie, Lloyd Jillian, Bell Clayton, Eric Heidel R, Bell John
Department of Human Ecology, University of California, Davis, One Shield Avenue, Davis, CA 95616, United States.
Department of Human Ecology, University of California, Davis, One Shield Avenue, Davis, CA 95616, United States.
Cancer Treat Res Commun. 2019;19:100128. doi: 10.1016/j.ctarc.2019.100128. Epub 2019 Mar 14.
Breast cancer is the second leading cause of cancer death for women in the United States and mortality from cancer is more common among individuals in the Appalachian region compared to the rest of the country. We examined how risk factors for long-term health outcomes for Estrogen positive breast cancer patients differed by county economic status in southern Appalachia.
Data was collected through retrospective data mining of patient medical files (N = 238). Using the self-reported zipcode, patients were classified into county economic status. At-risk and distressed designations were also rural counties. Bi-variate statistical analyses were used to evaluate how demographic, behavioral, health risk factors differed across economic statuses.
For demographic factors, fewer single individuals lived in at-risk counties and older individuals lived in distressed counties. For health behaviors, more individuals in transitional counties report drinking alcohol but more individuals in distressed counties reported adhering to medication. For morbidity, more individuals in distressed counties reported having diabetes or a circulatory disease.
Many risk factors differed across county economic statuses. Therefore, doctors must consider the patient's context as a risk factor not just their individual characteristics. Patients from economically distressed counties may be at higher risk for treatment complications due to a larger proportion of co-morbidities and older age. Because many risk factors (eg, previous cancer, BMI) are similarly proportioned across Appalachian economic statuses, ER+ breast cancer patients in Appalachia may be at a similarly high risk for health complications compared to the rest of the country.
乳腺癌是美国女性癌症死亡的第二大主要原因，与美国其他地区相比，阿巴拉契亚地区的癌症死亡率在人群中更为常见。我们研究了阿巴拉契亚南部地区雌激素阳性乳腺癌患者长期健康结局的风险因素如何因县经济状况而异。
通过对患者医疗档案进行回顾性数据挖掘收集数据（N = 238）。利用自我报告的邮政编码将患者分类到县经济状况中。处于风险和困境的地区也都是农村县。采用双变量统计分析来评估人口统计学、行为、健康风险因素在不同经济状况下的差异。
在人口统计学因素方面，处于风险县的单身个体较少，而处于困境县的老年人较多。在健康行为方面，处于过渡县的更多个体报告饮酒，但处于困境县的更多个体报告坚持服药。在发病率方面,处于困境县的更多个体报告患有糖尿病或循环系统疾病。
许多风险因素因县经济状况而异。因此，医生必须将患者的背景视为一个风险因素，而不仅仅是他们的个体特征。来自经济困境县的患者可能因合并症比例较高和年龄较大而面临更高的治疗并发症风险。由于许多风险因素（如既往癌症、体重指数）在阿巴拉契亚地区的经济状况中比例相似，与美国其他地区相比，阿巴拉契亚地区雌激素受体阳性乳腺癌患者可能面临同样高的健康并发症风险。
