Department of Surgery, Lankenau Medical Center, Wynnewood, PA, USA.
Main Line Health Center for Population Health Research at Lankenau Institute for Medical Research, Wynnewood, PA, USA.
Breast Cancer Res Treat. 2022 Feb;192(1):191-200. doi: 10.1007/s10549-021-06492-1. Epub 2022 Jan 22.
Many studies have demonstrated disparities in breast cancer (BC) incidence and mortality among Black women. We hypothesized that in Pennsylvania (PA), a large economically diverse state, BC diagnosis and mortality would be similar among races when stratified by a municipality's median income.
We collected the frequencies of BC diagnosis and mortality for years 2011-2015 from the Pennsylvania Cancer Registry and demographics from the 2010 US Census. We analyzed BC diagnoses and mortalities after stratifying by median income, municipality size, and race with univariable and multivariable logistic regression models.
In this cohort, of 5,353,875 women there were 54,038 BC diagnoses (1.01% diagnosis rate) and 9,828 BC mortalities (0.18% mortality rate). Unadjusted diagnosis rate was highest among white women (1.06%) but Black women had a higher age-adjusted diagnosis rate (1.06%) than white women (1.02%). Race, age and income were all significantly associated with BC diagnosis, but there were no differences in BC diagnosis between white and Black women across all levels of income in the multivariable model. BC mortality was highest in Black women, a difference which persisted when adjusted for age. Black women 35 years and older had a higher mortality rate in all income quartiles.
We found that in PA, age, race and income are all associated with BC diagnosis and mortality with noteworthy disparities for Black women. Continued surveillance of differences in both breast cancer diagnosis and mortality, and targeted interventions related to education, screening and treatment may help to eliminate these socioeconomic and racial disparities.
许多研究表明，黑种女性的乳腺癌（BC）发病率和死亡率存在差异。我们假设，在宾夕法尼亚州（PA）这个经济多样化程度较大的州，当按市政当局的中位数收入对种族进行分层时，乳腺癌的诊断和死亡率在各种族之间应该是相似的。
我们从宾夕法尼亚州癌症登记处收集了 2011 年至 2015 年的乳腺癌诊断和死亡率数据，以及 2010 年美国人口普查的人口统计学数据。我们通过中位数收入、市政规模和种族对乳腺癌诊断和死亡率进行分层，采用单变量和多变量逻辑回归模型进行分析。
在这个队列中，共有 5353875 名女性，其中有 54038 例乳腺癌诊断（诊断率为 1.01%）和 9828 例乳腺癌死亡（死亡率为 0.18%）。未经调整的诊断率在白人女性中最高（1.06%），但调整后的年龄诊断率在黑人女性中更高（1.06%），而在白人女性中为 1.02%。种族、年龄和收入均与乳腺癌诊断显著相关，但在多变量模型中，无论收入水平如何，白人女性和黑人女性之间的乳腺癌诊断率均无差异。乳腺癌死亡率在黑人女性中最高，这一差异在调整年龄后仍然存在。在所有收入四分位数中，35 岁及以上的黑人女性死亡率更高。
我们发现，在宾夕法尼亚州，年龄、种族和收入均与乳腺癌的诊断和死亡率相关，黑人女性的差异尤为显著。持续监测乳腺癌诊断和死亡率的差异，以及与教育、筛查和治疗相关的有针对性的干预措施，可能有助于消除这些社会经济和种族差异。
