Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, 4701 Ogletown-Stanton Road, Newark, DE, 19713, USA.
Institute for Research on Equity and Community Health, Christiana Care Health System, Newark, USA.
Breast Cancer Res. 2022 Jun 1;24(1):37. doi: 10.1186/s13058-022-01533-z.
Triple negative breast cancer (TNBC) is an aggressive subtype of invasive breast cancer that disproportionately affects Black women and contributes to racial disparities in breast cancer mortality. Prior research has suggested that neighborhood effects may contribute to this disparity beyond individual risk factors.
The sample included a cohort of 3316 breast cancer cases diagnosed between 2012 and 2020 in New Castle County, Delaware, a geographic region of the US with elevated rates of TNBC. Multilevel methods and geospatial mapping evaluated whether the race, income, and race/income versions of the neighborhood Index of Concentration at the Extremes (ICE) metric could efficiently identify census tracts (CT) with higher odds of TNBC relative to other forms of invasive breast cancer. Odds ratios (OR) and 95% confidence intervals (CI) were reported; p-values < 0.05 were significant. Additional analyses examined area-level differences in exposure to metabolic risk factors, including unhealthy alcohol use and obesity.
The ICE-Race, -Income-, and Race/Income metrics were each associated with greater census tract odds of TNBC on a bivariate basis. However, only ICE-Race was significantly associated with higher odds of TNBC after adjustment for patient-level age and race (most disadvantaged CT: OR = 2.09; 95% CI 1.40-3.13), providing support for neighborhood effects. Higher counts of alcohol and fast-food retailers, and correspondingly higher rates of unhealthy alcohol use and obesity, were observed in CTs that were classified into the most disadvantaged ICE-Race quintile and had the highest odds of TNBC.
The use of ICE can facilitate the monitoring of cancer inequities and advance the study of racial disparities in breast cancer.
三阴性乳腺癌（TNBC）是一种侵袭性乳腺癌亚型，不成比例地影响黑人女性，并导致乳腺癌死亡率的种族差异。先前的研究表明，除了个体风险因素之外，邻里效应可能导致这种差异。
该样本包括在特拉华州纽卡斯尔县（美国一个 TNBC 发病率较高的地理区域） 2012 年至 2020 年间诊断出的 3316 例乳腺癌病例。使用多层次方法和地理空间映射评估种族、收入以及邻里极端集中指数（ICE）的种族/收入版本是否能够有效地识别 TNBC 相对于其他形式的侵袭性乳腺癌的可能性更高的普查区（CT）。报告了比值比（OR）和 95%置信区间（CI）；p 值<0.05 为显著。额外的分析研究了代谢风险因素（包括不健康的饮酒和肥胖）暴露的区域差异。
ICE-Race、-Income 和 Race/Income 指标在双变量基础上均与更大的普查区 TNBC 几率相关。然而，仅在调整患者年龄和种族后，ICE-Race 与更高的 TNBC 几率相关（最不利 CT：OR=2.09；95%CI 1.40-3.13），这为邻里效应提供了支持。在被归类为最不利的 ICE-Race 五分位数且 TNBC 几率最高的 CT 中，观察到更多的酒精和快餐零售商，以及相应更高的不健康饮酒和肥胖率。
使用 ICE 可以促进癌症不公平的监测，并推进乳腺癌种族差异的研究。
