University of Miami Miller School of Medicine, Miami, FL, USA.
Department of Surgery, Division of Surgical Oncology, University of Miami, Miami, FL, USA.
Breast Cancer Res Treat. 2024 Aug;206(3):509-517. doi: 10.1007/s10549-024-07245-6. Epub 2024 May 29.
Disparities in breast cancer survival remain a challenge. We aimed to analyze the effect of structural racism, as measured by the Index of Concentration at the Extremes (ICE), on receipt of National Cancer Center Network (NCCN) guideline-concordant breast cancer treatment.
We identified patients treated at two institutions from 2005 to 2017 with stage I-IV breast cancer. Census tracts served as neighborhood proxies. Using 5-year estimates from the American Community Survey, 5 ICE variables were computed to create 5 models, controlling for economic segregation, non-Hispanic Black (NHB) segregation, NHB/economic segregation, Hispanic segregation, and Hispanic/economic segregation. Multi-level logistic regression models were used to determine the association between individual and neighborhood-level characteristics on receipt of NCCN guideline-concordant breast cancer treatment.
5173 patients were included: 55.2% were Hispanic, 27.5% were NHW, and 17.3% were NHB. Regardless of economic or residential segregation, a NHB patient was less likely to receive appropriate treatment [(OR) 0.58 (0.45-0.74); OR 0.59 (0.46-0.78); OR 0.62 (0.47-0.81); OR 0.53 (0.40-0.69); OR 0.59(0.46-0.76); p < 0.05].
To our knowledge, this is the first analysis assessing receipt of NCCN guideline-concordant treatment by ICE, a validated measure for structural racism. While much literature emphasizes neighborhood-level barriers to treatment, our results demonstrate that compared to NHW patients, NHB patients are less likely to receive NCCN guideline-concordant breast cancer treatment, independent of economic or residential segregation. Our study suggests that there are potential unaccounted individual or neighborhood barriers to receipt of appropriate care that go beyond economic or residential segregation.
乳腺癌生存方面的差异仍然是一个挑战。我们旨在分析结构种族主义（以极端集中指数（ICE）衡量）对接受国家癌症中心网络（NCCN）指南一致的乳腺癌治疗的影响。
我们从 2005 年至 2017 年在两个机构接受治疗的患者中确定了 I-IV 期乳腺癌患者。普查区作为邻里代表。利用美国社区调查的 5 年估计值，计算了 5 个 ICE 变量，创建了 5 个模型，控制了经济隔离、非西班牙裔黑人（NHB）隔离、NHB/经济隔离、西班牙裔隔离和西班牙裔/经济隔离。使用多层次逻辑回归模型确定个体和邻里特征与接受 NCCN 指南一致的乳腺癌治疗之间的关联。
共纳入 5173 例患者：55.2%为西班牙裔，27.5%为 NHW，17.3%为 NHB。无论经济或居住隔离如何，NHB 患者接受适当治疗的可能性较低 [比值比（OR）0.58（0.45-0.74）；OR 0.59（0.46-0.78）；OR 0.62（0.47-0.81）；OR 0.53（0.40-0.69）；OR 0.59（0.46-0.76）；p<0.05]。
据我们所知，这是首次使用 ICE（一种经过验证的结构种族主义衡量标准）评估 NCCN 指南一致的治疗方法的分析。尽管许多文献强调了治疗方面的邻里障碍，但我们的结果表明，与 NHW 患者相比，NHB 患者接受 NCCN 指南一致的乳腺癌治疗的可能性较低，而与经济或居住隔离无关。我们的研究表明，除了经济或居住隔离之外，可能还有潜在的无法解释的个人或邻里障碍，影响到适当护理的获得。
