加利福尼亚的邻里类型与乳腺癌生存
Neighborhood archetypes and breast cancer survival in California.
机构信息
Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Greater Bay Area Cancer Registry, San Francisco, CA.
Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.
出版信息
Ann Epidemiol. 2021 May;57:22-29. doi: 10.1016/j.annepidem.2021.01.004. Epub 2021 Feb 10.
PURPOSE
Previous studies on neighborhoods and breast cancer survival examined neighborhood variables as unidimensional measures (e.g. walkability or deprivation) individually and thus cannot inform how the multitude of highly correlated neighborhood domains interact to impact breast cancer survival. Neighborhood archetypes were developed that consider interactions among a broad range of neighborhood social and built environment attributes and examine their associations with breast cancer survival.
METHODS
Archetypes were measured using latent class analysis (LCA) fit to California census tract-level data. Thirty-nine social and built environment attributes relevant to eight neighborhood domains (socioeconomic status (SES), urbanicity, demographics, housing, land use, commuting and traffic, residential mobility, and food environment) were included. The archetypes were linked to cancer registry data on breast cancer cases (diagnosed 1996-2005 with follow-up through Dec 31, 2017) to evaluate their associations with overall and breast cancer-specific survival using Cox proportional hazards models. Analyses were stratified by race/ethnicity.
RESULTS
California neighborhoods were best described by nine archetypal patterns that were differentially associated with overall and breast cancer-specific survival. The lowest risk of overall death was observed in the upper middle class suburb (reference) and high status neighborhoods, while the highest was observed among inner city residents with a 39% greater risk of death (95% CI = 1.35 to 1.44). Results were similar for breast cancer-specific survival. Stratified analyses indicated that differences in survival by neighborhood archetypes varied according to individuals' race/ethnicity.
CONCLUSIONS
By describing neighborhood archetypes that differentiate survival following breast cancer diagnosis, the study provides direction for policy and clinical practice addressing contextually-rooted social determinants of health including SES, unhealthy food environments, and greenspace.
目的
先前关于邻里环境与乳腺癌生存的研究，分别考察了邻里变量作为单一维度的衡量标准（例如可步行性或贫困程度），因此无法说明众多高度相关的邻里领域是如何相互作用来影响乳腺癌生存的。本研究开发了邻里原型，这些原型考虑了广泛的邻里社会和建成环境属性之间的相互作用，并研究了它们与乳腺癌生存之间的关联。
方法
使用潜在类别分析（LCA）对加利福尼亚州的普查区数据进行拟合，以测量原型。纳入了 39 个与 8 个邻里领域相关的社会和建成环境属性（社会经济地位（SES）、城市化程度、人口统计学、住房、土地利用、通勤和交通、居住流动性和食品环境）。将这些原型与癌症登记处的乳腺癌病例数据（1996-2005 年诊断，随访至 2017 年 12 月 31 日）相关联，使用 Cox 比例风险模型评估它们与总体和乳腺癌特异性生存的关联。分析按种族/族裔进行分层。
结果
加利福尼亚州的邻里环境最好由 9 种原型来描述，这些原型与总体和乳腺癌特异性生存的相关性存在差异。总体死亡风险最低的是中上层阶级的郊区（参照）和高地位社区，而市中心居民的死亡风险最高，高出 39%（95%CI=1.35 至 1.44）。乳腺癌特异性生存的结果也类似。分层分析表明，邻里原型对生存的影响差异因个体的种族/族裔而异。
结论
通过描述区分乳腺癌诊断后生存的邻里原型，本研究为解决 SES、不健康的食品环境和绿地等与上下文相关的健康社会决定因素的政策和临床实践提供了方向。
Zotero 插件