Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.
Cancer. 2022 Sep 15;128(18):3370-3382. doi: 10.1002/cncr.34391. Epub 2022 Jul 22.
The authors identified tumor, treatment, and patient characteristics that may contribute to differences in breast cancer (BC) mortality by race, rurality, and area-level socioeconomic status (SES) among women diagnosed with stage IIIB-IV BC in Georgia.
Using the Georgia Cancer Registry, 3084 patients with stage IIIB-IV primary BC (2013-2017) were identified. Cox proportional hazards regression was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) comparing mortality among non-Hispanic Black (NHB) versus non-Hispanic White (NHW), residents of rural versus urban neighborhoods, and residents of low- versus high-SES neighborhoods by tumor, treatment, and patient characteristics. The mediating effects of specific characteristics on the association between race and BC mortality were estimated.
Among the study population, 41% were NHB, 21% resided in rural counties, and 72% resided in low SES neighborhoods. The authors observed mortality disparities by race (HR, 1.27; 95% CI, 1.13, 1.41) and rurality (HR, 1.14; 95% CI, 1.00, 1.30), but not by SES (HR, 1.04; 95% CI, 0.91, 1.19). In the stratified analyses, racial disparities were the most pronounced among women with HER2 overexpressing tumors (HR, 2.30; 95% CI, 1.53, 3.45). Residing in a rural county was associated with increased mortality among uninsured women (HR, 2.25; 95% CI, 1.31, 3.86), and the most pronounced SES disparities were among younger women (<40 years: HR, 1.46; 95% CI, 0.88, 2.42).
There is considerable variation in racial, regional, and socioeconomic disparities in late-stage BC mortality by tumor, treatment, and patient characteristics.
作者确定了肿瘤、治疗和患者特征，这些特征可能导致佐治亚州诊断为 IIIB-IV 期乳腺癌的女性中，乳腺癌死亡率因种族、农村和地区社会经济地位（SES）而异。
利用佐治亚州癌症登记处，确定了 3084 名 IIIB-IV 期原发性乳腺癌（2013-2017 年）患者。使用 Cox 比例风险回归计算非西班牙裔黑人（NHB）与非西班牙裔白人（NHW）、农村居民与城市居民、低 SES 社区与高 SES 社区之间的死亡率风险比（HR）和 95%置信区间（CI），比较肿瘤、治疗和患者特征。估计特定特征对种族与乳腺癌死亡率之间关联的中介作用。
在研究人群中，41%是 NHB，21%居住在农村县，72%居住在低 SES 社区。作者观察到种族（HR，1.27；95%CI，1.13，1.41）和农村（HR，1.14；95%CI，1.00，1.30）差异与死亡率有关，但 SES（HR，1.04；95%CI，0.91，1.19）无关。在分层分析中，在 HER2 过表达肿瘤的女性中，种族差异最为明显（HR，2.30；95%CI，1.53，3.45）。居住在农村县与未参保女性死亡率升高相关（HR，2.25；95%CI，1.31，3.86），SES 差异最明显的是年轻女性（<40 岁：HR，1.46；95%CI，0.88，2.42）。
肿瘤、治疗和患者特征导致晚期乳腺癌死亡率存在相当大的种族、区域和社会经济差异。
