Department of Public Health Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA.
Jay Weiss Institute for Health Equity, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA.
Cancer. 2020 Aug 15;126(16):3698-3707. doi: 10.1002/cncr.32989. Epub 2020 Jun 2.
To the authors' knowledge, the etiology of survival disparities in patients with epithelial ovarian cancer (EOC) is not fully understood. Residential segregation, both economic and racial, remains a problem within the United States. The objective of the current study was to analyze the effect of residential segregation as measured by the Index of Concentration at the Extremes (ICE) on EOC survival in Florida by race and/or ethnicity.
All malignant EOC cases were identified from 2001 through 2015 using the Florida Cancer Data System (FCDS). Census-defined places were used as proxies for neighborhoods. Using 5-year estimates from the American Community Survey, 5 ICE variables were computed: economic (high vs low), race and/or ethnicity (non-Hispanic white [NHW] vs non-Hispanic black [NHB] and NHW vs Hispanic), and racialized economic segregation (low-income NHB vs high-income NHW and low-income Hispanic vs high-income NHW). Random effects frailty models were conducted.
A total of 16,431 malignant EOC cases were diagnosed in Florida among women living in an assigned census-defined place within the time period. The authors found that economic and racialized economic residential segregations influenced EOC survival more than race and/or ethnic segregation alone in both NHB and Hispanic women. NHB women continued to have an increased hazard of death compared with NHW women after controlling for multiple covariates, whereas Hispanic women were found to have either a similar or decreased hazard of death compared with NHW women in multivariable Cox models.
The results of the current study indicated that racial and economic residential segregation influences survival among patients with EOC. Research is needed to develop more robust segregation measures that capture the complexities of neighborhoods to fully understand the survival disparities in EOC.
据作者所知，上皮性卵巢癌（EOC）患者生存差异的病因尚未完全阐明。在美国，经济和种族隔离仍然是一个问题。本研究的目的是分析居住隔离程度（以极端集中指数[ICE]衡量）对佛罗里达州按种族和/或族裔划分的 EOC 生存的影响。
利用佛罗里达州癌症数据系统（FCDS），从 2001 年至 2015 年，所有恶性 EOC 病例均被识别。使用人口普查定义的地点作为社区的代表。使用美国社区调查的 5 年估计值，计算了 5 个 ICE 变量：经济（高 vs 低）、种族和/或族裔（非西班牙裔白人[NHW] vs 非西班牙裔黑人[NHB]和 NHW vs 西班牙裔）和种族化经济隔离（低收入 NHB vs 高收入 NHW 和低收入西班牙裔 vs 高收入 NHW）。进行了随机效应脆弱性模型分析。
在研究期间，居住在指定人口普查定义地点的佛罗里达州妇女中，共有 16431 例恶性 EOC 病例被诊断为 EOC。作者发现，经济和种族化经济居住隔离对 EOC 生存的影响大于种族和/或族裔隔离，这在 NHB 和西班牙裔妇女中均如此。在控制了多个协变量后，与 NHW 妇女相比，NHB 妇女的死亡风险仍然较高，而在多变量 Cox 模型中，西班牙裔妇女的死亡风险与 NHW 妇女相似或降低。
本研究结果表明，种族和经济居住隔离影响 EOC 患者的生存。需要开展更多的研究来开发更稳健的隔离措施，以充分了解 EOC 生存差异的复杂性。
