非裔美国癌症幸存者中的主要歧视与缺陷积累之间的关联：底特律癌症幸存者研究。
Association between major discrimination and deficit accumulation in African American cancer survivors: The Detroit Research on Cancer Survivors Study.
机构信息
Department of Oncology, Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA.
Georgetown Lombardi Institute for Cancer and Aging Research, Georgetown University, Washington, District of Columbia, USA.
出版信息
Cancer. 2023 May 15;129(10):1557-1568. doi: 10.1002/cncr.34673. Epub 2023 Mar 20.
BACKGROUND
Discrimination can adversely affect health and accelerate aging, but little is known about these relationships in cancer survivors. This study examines associations of discrimination and aging among self-identified African American survivors.
METHODS
A population-based sample of 2232 survivors 20-79 years old at diagnosis were enrolled within 5 years of breast (n = 787), colorectal (n = 227), lung (n = 223), or prostate (n = 995) cancer between 2017 and 2022. Surveys were completed post-active therapy. A deficit accumulation index measured aging-related disease and function (score range, 0-1, where <0.20 is robust, 0.20 to <0.35 is pre-frail, and 0.35+ is frail; 0.06 is a large clinically meaningful difference). The discrimination scale assessed ever experiencing major discrimination and seven types of events (score, 0-7). Linear regression tested the association of discrimination and deficit accumulation, controlling for age, time from diagnosis, cancer type, stage and therapy, and sociodemographic variables.
RESULTS
Survivors were an average of 62 years old (SD, 9.6), 63.2% reported ever experiencing major discrimination, with an average of 2.4 (SD, 1.7) types of discrimination events. Only 24.4% had deficit accumulation scores considered robust (mean score, 0.30 [SD, 0.13]). Among those who reported ever experiencing major discrimination, survivors with four to seven types of discrimination events (vs. 0-1) had a large, clinically meaningful increase in adjusted deficits (0.062, p < .001) and this pattern was consistent across cancer types.
CONCLUSION
African American cancer survivors have high deficit accumulated index scores, and experiences of major discrimination were positively associated with these deficits. Future studies are needed to understand the intersectionality between aging, discrimination, and cancer survivorship among diverse populations.
背景
歧视可能对健康产生不利影响并加速衰老，但人们对癌症幸存者中这些关系知之甚少。本研究调查了自我认同为非裔美国幸存者的歧视和衰老之间的关联。
方法
在 2017 年至 2022 年期间，招募了一个基于人群的样本，该样本包括 2232 名年龄在 20-79 岁之间的幸存者，他们在诊断后 5 年内患有乳腺癌（n=787）、结直肠癌（n=227）、肺癌（n=223）或前列腺癌（n=995）。调查在积极治疗后完成。一个缺陷积累指数衡量与衰老相关的疾病和功能（评分范围为 0-1，其中<0.20 表示稳健，0.20-<0.35 表示脆弱前期，0.35+表示脆弱；0.06 表示具有较大临床意义的差异）。歧视量表评估是否经历过重大歧视和七种类型的事件（评分，0-7）。线性回归测试了歧视和缺陷积累之间的关联，控制了年龄、从诊断到现在的时间、癌症类型、阶段和治疗以及社会人口统计学变量。
结果
幸存者的平均年龄为 62 岁（标准差，9.6），63.2%报告曾经历过重大歧视，平均经历过 2.4（标准差，1.7）种歧视事件。只有 24.4%的人具有稳健的缺陷积累评分（平均评分，0.30[标准差，0.13]）。在报告曾经历过重大歧视的幸存者中，经历过 4 到 7 种歧视事件（与 0-1 相比）的幸存者，其调整后的缺陷有很大的、具有临床意义的增加（0.062，p<0.001），并且这种模式在所有癌症类型中都是一致的。
结论
非裔美国癌症幸存者的缺陷积累指数评分较高，经历过重大歧视与这些缺陷呈正相关。未来的研究需要了解不同人群中衰老、歧视和癌症生存之间的交叉性。
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