Luo Yi, Carretta Henry, Lee Inkoo, LeBlanc Gabrielle, Sinha Debajyoti, Rust George
Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, 1115 West Call Street, Tallahassee, FL USA.
Department of Statistics, Florida State University, 117 N. Woodward Ave., Tallahassee, FL USA.
Health Inf Sci Syst. 2021 Sep 24;9(1):35. doi: 10.1007/s13755-021-00165-5. eCollection 2021 Dec.
Variation in breast cancer stage at initial diagnosis (including racial disparities) is driven both by tumor biology and healthcare factors.
We studied women age 67-74 with initial diagnosis of breast cancer from 2006 through 2014 in the SEER-Medicare database. We extracted variables related to tumor biology (histologic grade and hormone receptor status) and healthcare factors (screening mammography [SM] utilization and time delay from mammography to diagnostic biopsy). We used naïve Bayesian networks (NBNs) to illustrate the relationships among patient-specific factors and stage-at-diagnosis for African American (AA) and white patients separately. After identifying and controlling confounders, we conducted counterfactual inference through the NBN, resulting in an unbiased evaluation of the causal effects of individual factors on the expected utility of stage-at-diagnosis. An NBN-based decomposition mechanism was developed to evaluate the contributions of each patient-specific factor to an actual racial disparity in stage-at-diagnosis. 2000 bootstrap samples from our training patients were used to compute the 95% confidence intervals (CIs) of these contributions.
Using a causal-effect contribution analysis, the relative contributions of each patient-specific factor to the actual racial disparity in stage-at-diagnosis were as follows: tumor grade, 45.1% (95% CI: 44.5%, 45.8%); hormone receptor status, 5.0% (4.5%, 5.4%); mammography utilization, 23.1% (22.4%, 24.0%); and biopsy delay 26.8% (26.1%, 27.3%).
The modifiable mechanisms of mammography utilization and biopsy delay drive about 49.9% of racial difference in stage-at-diagnosis, potentially guiding more targeted interventions to eliminate cancer outcome disparities.
The online version contains supplementary material available at 10.1007/s13755-021-00165-5.
初次诊断时乳腺癌分期的差异（包括种族差异）是由肿瘤生物学和医疗保健因素共同驱动的。
我们在监测、流行病学和最终结果（SEER）-医疗保险数据库中研究了2006年至2014年期间初次诊断为乳腺癌的67至74岁女性。我们提取了与肿瘤生物学（组织学分级和激素受体状态）和医疗保健因素（乳腺钼靶筛查[SM]的使用情况以及从乳腺钼靶检查到诊断性活检的时间延迟）相关的变量。我们分别使用朴素贝叶斯网络（NBN）来说明非裔美国（AA）患者和白人患者的特定患者因素与诊断时分期之间的关系。在识别和控制混杂因素后，我们通过NBN进行反事实推理，从而对个体因素对诊断时分期预期效用的因果效应进行无偏评估。我们开发了一种基于NBN的分解机制，以评估每个特定患者因素对诊断时分期实际种族差异的贡献。我们使用来自训练患者的2000个自助抽样样本计算这些贡献的95%置信区间（CI）。
通过因果效应贡献分析，每个特定患者因素对诊断时分期实际种族差异的相对贡献如下：肿瘤分级，45.1%（95%CI：44.5%，45.8%）；激素受体状态，5.0%（4.5%，5.4%）；乳腺钼靶检查的使用情况，23.1%（22.4%，24.0%）；活检延迟，26.8%（26.1%，27.3%）。
乳腺钼靶检查的使用情况和活检延迟这些可改变的机制导致了约49.9%的诊断时分期种族差异，这可能为更有针对性的干预措施提供指导，以消除癌症结局差异。
在线版本包含可在10.1007/s13755-021-00165-5获取的补充材料。
