Moores Cancer Center, University of California San Diego, La Jolla, CA, USA.
Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
BMC Cancer. 2020 Mar 17;20(1):228. doi: 10.1186/s12885-020-6696-8.
We assessed breast cancer mortality in older versus younger women according to race/ethnicity, neighborhood socioeconomic status (nSES), and health insurance status.
The study included female breast cancer cases 18 years of age and older, diagnosed between 2005 and 2015 in the California Cancer Registry. Multivariable Cox proportional hazards modeling was used to generate hazard ratios (HR) of breast cancer specific deaths and 95% confidence intervals (CI) for older (60+ years) versus younger (< 60 years) patients separately by race/ethnicity, nSES, and health insurance status.
Risk of dying from breast cancer was higher in older than younger patients after multivariable adjustment, which varied in magnitude by race/ethnicity (P-interaction< 0.0001). Comparing older to younger patients, higher mortality differences were shown for non-Hispanic White (HR = 1.43; 95% CI, 1.36-1.51) and Hispanic women (HR = 1.37; 95% CI, 1.26-1.50) and lower differences for non-Hispanic Blacks (HR = 1.17; 95% CI, 1.04-1.31) and Asians/Pacific Islanders (HR = 1.15; 95% CI, 1.02-1.31). HRs comparing older to younger patients varied by insurance status (P-interaction< 0.0001), with largest mortality differences observed for privately insured women (HR = 1.51; 95% CI, 1.43-1.59) and lowest in Medicaid/military/other public insurance (HR = 1.18; 95% CI, 1.10-1.26). No age differences were shown for uninsured women. HRs comparing older to younger patients were similar across nSES strata.
Our results provide evidence for the continued disparity in Black-White breast cancer mortality, which is magnified in younger women. Moreover, insurance status continues to play a role in breast cancer mortality, with uninsured women having the highest risk for breast cancer death, regardless of age.
我们根据种族/族裔、邻里社会经济地位（nSES）和医疗保险状况评估了老年和年轻女性的乳腺癌死亡率。
本研究纳入了 2005 年至 2015 年期间在加利福尼亚癌症登记处诊断为 18 岁及以上的女性乳腺癌病例。多变量 Cox 比例风险模型用于生成特定于乳腺癌的死亡风险比（HR）和 95%置信区间（CI），用于比较老年（60 岁及以上）与年轻（<60 岁）患者，按种族/族裔、nSES 和医疗保险状况分别进行。
多变量调整后，老年患者死于乳腺癌的风险高于年轻患者，且种族/族裔之间差异显著（P 交互<0.0001）。与年轻患者相比，非西班牙裔白人（HR=1.43；95%CI，1.36-1.51）和西班牙裔女性（HR=1.37；95%CI，1.26-1.50）的死亡率差异更大，而非西班牙裔黑人（HR=1.17；95%CI，1.04-1.31）和亚洲/太平洋岛民（HR=1.15；95%CI，1.02-1.31）的死亡率差异更小。比较老年与年轻患者的 HR 因保险状况而异（P 交互<0.0001），观察到私人保险女性的死亡率差异最大（HR=1.51；95%CI，1.43-1.59），而医疗补助/军人/其他公共保险的死亡率最低（HR=1.18；95%CI，1.10-1.26）。未参保女性则无年龄差异。比较老年与年轻患者的 HR 在 nSES 各层之间相似。
我们的研究结果为黑人和白人乳腺癌死亡率持续存在的差异提供了证据，这种差异在年轻女性中更为明显。此外，保险状况仍然在乳腺癌死亡率中发挥作用，无论年龄大小，未参保女性的乳腺癌死亡风险最高。
