大都市底特律的地区社会经济劣势与癌症生存
Area-level Socioeconomic Disadvantage and Cancer Survival in Metropolitan Detroit.
机构信息
Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.
Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan.
出版信息
Cancer Epidemiol Biomarkers Prev. 2023 Mar 6;32(3):387-397. doi: 10.1158/1055-9965.EPI-22-0738.
BACKGROUND
Racial segregation is linked to poorer neighborhood quality and adverse health conditions among minorities, including worse cancer outcomes. We evaluated relationships between race, neighborhood social disadvantage, and cancer survival.
METHODS
We calculated overall and cancer-specific survival for 11,367 non-Hispanic Black (NHB) and 29,481 non-Hispanic White (NHW) individuals with breast, colorectal, lung, or prostate cancer using data from the Metropolitan Detroit Cancer Surveillance System. The area deprivation index (ADI) was used to measure social disadvantage at the census block group level, where higher ADI is associated with poorer neighborhood factors. Associations between ADI and survival were estimated using Cox proportional hazards mixed-effects models accounting for geographic grouping and adjusting for demographic and clinical factors.
RESULTS
Increasing ADI quintile was associated with increased overall mortality for all four cancer sites in multivariable-adjusted models. Stratified by race, these associations remained among breast (NHW: HR = 1.16, P < 0.0001; NHB: HR = 1.20, P < 0.0001), colorectal (NHW: HR = 1.11, P < 0.0001; NHB: HR = 1.09, P = 0.00378), prostate (NHW: HR = 1.18, P < 0.0001; NHB: HR = 1.18, P < 0.0001), and lung cancers (NHW: HR = 1.06, P < 0.0001; NHB: HR = 1.07, P = 0.00177). Cancer-specific mortality estimates were similar to overall mortality. Adjustment for ADI substantially attenuated the effects of race on mortality for breast [overall proportion attenuated (OPA) = 47%, P < 0.0001; cancer-specific proportion attenuated (CSPA) = 37%, P < 0.0001] prostate cancer (OPA = 51%, P < 0.0001; CSPA = 56%, P < 0.0001), and colorectal cancer (OPA = 69%, P = 0.032; CSPA = 36%, P = 0.018).
CONCLUSIONS
Area-level socioeconomic disadvantage is related to cancer mortality in a racially diverse population, impacting racial differences in cancer mortality.
IMPACT
Understanding the role of neighborhood quality in cancer survivorship could improve community-based intervention practices.
背景
种族隔离与少数族裔较差的邻里质量和不利健康状况有关，包括癌症预后更差。我们评估了种族、邻里社会劣势与癌症生存之间的关系。
方法
我们利用底特律大都市癌症监测系统的数据，计算了 11367 名非西班牙裔黑人（NHB）和 29481 名非西班牙裔白人（NHW）个体的乳腺癌、结直肠癌、肺癌或前列腺癌的总体生存率和癌症特异性生存率。使用人口普查区块组水平的区域剥夺指数（ADI）来衡量社会劣势，ADI 越高与较差的邻里因素相关。使用 Cox 比例风险混合效应模型估计 ADI 与生存之间的关联，该模型考虑了地理分组，并调整了人口统计学和临床因素。
结果
在多变量调整模型中，ADI 五分位组的增加与所有四个癌症部位的总死亡率增加相关。按种族分层，这些关联在乳腺癌（NHW：HR = 1.16，P < 0.0001；NHB：HR = 1.20，P < 0.0001）、结直肠癌（NHW：HR = 1.11，P < 0.0001；NHB：HR = 1.09，P = 0.00378）、前列腺癌（NHW：HR = 1.18，P < 0.0001；NHB：HR = 1.18，P < 0.0001）和肺癌（NHW：HR = 1.06，P < 0.0001；NHB：HR = 1.07，P = 0.00177）中仍然存在。癌症特异性死亡率估计值与总死亡率相似。调整 ADI 后，种族对乳腺癌[总比例衰减（OPA）= 47%，P < 0.0001；癌症特异性比例衰减（CSPA）= 37%，P < 0.0001]、前列腺癌（OPA = 51%，P < 0.0001；CSPA = 56%，P < 0.0001）和结直肠癌（OPA = 69%，P = 0.032；CSPA = 36%，P = 0.018）的死亡率的影响显著减弱。
结论
在种族多样化的人群中，区域社会经济劣势与癌症死亡率相关，影响了癌症死亡率的种族差异。
影响
了解邻里质量在癌症生存中的作用，可以改善基于社区的干预实践。
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