Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Cancer Med. 2024 Jul;13(14):e7397. doi: 10.1002/cam4.7397.
BACKGROUND: Interventions aimed at upstream factors contributing to late-stage diagnoses could reduce disparities and improve breast cancer outcomes. This study examines the association between measures of housing stability and contemporary mortgage lending bias on breast cancer stage at diagnosis among older women in the United States. METHODS: We studied 67,588 women aged 66-90 from the SEER-Medicare linked database (2010-2015). The primary outcome was breast cancer stage at diagnosis. Multinomial regression models adjusted for individual and neighborhood socio-economic factors were performed using a three-category outcome (stage 0, early stage, and late stage). Key census tract-level independent variables were residence in the same house as the previous year, owner-occupied homes, and an index of contemporary mortgage lending bias. RESULTS: In models adjusted for individual factors, higher levels of mortgage lending bias were associated with later stage diagnosis (RR = 1.10, 95% CI 1.02-1.20; RR = 1.31, 95% CI 1.16-1.49; RR = 1.41, 95% CI 1.24-1.60 for least to high, respectively). In models adjusted for individual and neighborhood socio-economic factors, moderate and high levels of mortgage lending bias were associated with later stage diagnosis (RR = 1.16, 95% CI 1.02-1.33 for moderate and RR = 1.18, 95% CI 1.02-1.37 for high). Owner occupancy and tenure were not associated with later stage diagnosis in adjusted models. CONCLUSIONS: Contemporary mortgage lending bias demonstrated a significant gradient relationship with later stage at diagnosis of breast cancer. Policy interventions aimed at reducing place-based mortgage disinvestment and its impacts on local resources and opportunities should be considered as part of an overall strategy to decrease late-stage breast cancer diagnosis and improve prognosis.
背景:针对导致晚期诊断的上游因素的干预措施可以减少差异并改善乳腺癌的结局。本研究在美国老年女性中检验了住房稳定措施与当代抵押贷款借贷偏见对诊断时乳腺癌分期的关联。
方法:我们研究了 SEER-Medicare 链接数据库中的 67588 名年龄在 66-90 岁的女性(2010-2015 年)。主要结局是诊断时的乳腺癌分期。使用三分类结局(0 期、早期和晚期),采用多变量回归模型调整了个体和邻里社会经济因素。关键的普查区水平的独立变量是与前一年相同的住房、自有住房和当代抵押贷款借贷偏见指数。
结果:在调整了个体因素的模型中,较高水平的抵押贷款借贷偏见与晚期诊断相关(RR=1.10,95%CI 1.02-1.20;RR=1.31,95%CI 1.16-1.49;RR=1.41,95%CI 1.24-1.60,分别为最低到最高)。在调整了个体和邻里社会经济因素的模型中,中等和高水平的抵押贷款借贷偏见与晚期诊断相关(RR=1.16,95%CI 1.02-1.33 为中等水平,RR=1.18,95%CI 1.02-1.37 为高水平)。在调整后的模型中,自有住房和居住时间与晚期诊断无关。
结论:当代抵押贷款借贷偏见与乳腺癌诊断的晚期阶段呈显著梯度关系。应考虑针对减少基于地点的抵押贷款投资不足及其对当地资源和机会的影响的政策干预措施,作为降低晚期乳腺癌诊断率和改善预后的整体战略的一部分。
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