Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, 21205, USA.
J Racial Ethn Health Disparities. 2023 Apr;10(2):718-729. doi: 10.1007/s40615-022-01259-w. Epub 2022 Feb 17.
While research on hereditary genetic testing for BRCA1/2 mutations continues to emerge, there remain unanswered questions regarding access to testing and cancer-related care. Our study determined the associations between race/ethnicity, residential locale, and genetic testing provider and related outcomes among US women with BRCA1/2 genetic mutations.
One hundred ninety-three BRCA1/2-positive women from vulnerable health backgrounds were recruited via private national Facebook BRCA1/2-oriented support groups and completed an online survey. Adjusted odds ratios (aOR) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression for the associations between race/ethnicity, residential locale, and genetic testing-related outcomes.
Women ranged in age (18-75, M = 39.5, SD = 10.7), and most were non-Hispanic white (66.3%) and lived in a suburban locale (54.9%). Women living in suburban areas were significantly less likely (aOR, .369, 95% CI, .177-.771) to receive behavioral referrals after genetic testing compared to those living in an urban locale. Women living in rural areas and suburban areas were 4.72 times more likely (95% CI, 1.48-15.1, p = .009) and 2.61 times more likely (95% CI, 1.05-6.48, p = .038), respectively, to receive genetic testing from a primary care provider versus private genetic testing office/hospital compared to women in urban locales. Associations between race/ethnicity and genetic testing outcomes were not statistically significant. Residential locale did not predict the odds of undergoing surgery for risk reduction or surveillance for early detection.
Our study identifies disparities in genetic testing resources among women living in suburban and rural areas. These findings can be used to inform future care, research, and community resources that may impact services relating to genetic testing within these locales.
虽然有关 BRCA1/2 基因突变的遗传性基因检测研究不断涌现，但关于检测的获取和与癌症相关的护理问题仍存在一些未解决的问题。我们的研究确定了美国 BRCA1/2 基因突变女性的种族/民族、居住地点和基因检测提供者之间的关联，并确定了与基因检测相关的结果。
通过私人全国性 Facebook BRCA1/2 定向支持小组招募了 193 名具有脆弱健康背景的 BRCA1/2 阳性女性，并完成了在线调查。使用多变量逻辑回归估计种族/民族、居住地点和与基因检测相关结果之间的关联的调整优势比（aOR）和 95%置信区间（CI）。
女性年龄在 18-75 岁之间（M=39.5，SD=10.7），大多数是非西班牙裔白人（66.3%），居住在郊区（54.9%）。与居住在城市地区的女性相比，居住在郊区的女性在基因检测后接受行为转介的可能性明显降低（aOR，.369，95%CI，.177-.771）。居住在农村和郊区的女性分别更有可能（95%CI，1.48-15.1，p=0.009）和 2.61 倍（95%CI，1.05-6.48，p=0.038）从初级保健提供者而不是私人基因检测办公室/医院获得基因检测，而与居住在城市地区的女性相比。种族/民族与基因检测结果之间的关联没有统计学意义。居住地点并不能预测进行风险降低手术或早期检测监测的几率。
我们的研究确定了居住在郊区和农村地区的女性在基因检测资源方面存在差异。这些发现可用于为未来的护理、研究和社区资源提供信息，这些资源可能会影响这些地区的基因检测相关服务。
