Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, NC.
Division of Oncology, Department of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC.
J Clin Oncol. 2024 Nov 10;42(32):3858-3866. doi: 10.1200/JCO.23.02483. Epub 2024 Aug 6.
Structural racism (SR) is a potential driver of health disparities, but research quantifying its impacts on cancer outcomes has been limited. We aimed to develop a multidimensional county-level SR measure and to examine the association of SR with breast cancer (BC) treatment delays among Black and White patients.
The cohort included 32,095 individuals from the North Carolina Central Cancer Registry with stage I to III BC diagnosed between 2004 and 2017 and linked to multipayer insurance claims from the Cancer Information and Population Health Resource. County-level data were drawn from multiple public sources aggregated in the Robert Wood Johnson County Health Rankings database. Racial gaps in eight social determinants across five domains were quantified at the county level and ranked on a 0-100 minimum-maximum scale. Domain scores were averaged to create a SR Composite Index (SRCI) score. We used multilevel logistic regression with random intercepts and multiple cross-level interaction terms to evaluate the association between county-level SRCI and patient-level treatment delays, adjusting for patient-level characteristics and stratified by race.
The SRCI score ranged from 21 to 75 with a median (IQR) of 39.0 (31.8, 45.7). For Black patients, a 10-unit increase in SRCI score was associated with increased odds of delay (Adjusted odds ratios [aOR], 1.25; 95% confidence limits [CL], 1.08 to 1.45). No such association was found for White patients (OR, 1.05; 95% CL, 0.97 to 1.15).
Area-level SR measured by a composite index is associated with higher odds of BC treatment delays among Black, but not White patients. Increasing county-level SR is associated with increasing Black-White disparities in treatment delay. Further research is needed to refine the measurement of SR and to examine its association with other cancer care disparities.
结构性种族主义（SR）是造成健康差异的潜在因素，但量化其对癌症结局影响的研究有限。我们旨在开发一种多维县级 SR 衡量标准，并研究 SR 与黑人和白人患者乳腺癌（BC）治疗延迟的关联。
该队列包括来自北卡罗来纳州中央癌症登记处的 32095 名 I 期至 III 期 BC 患者，这些患者在 2004 年至 2017 年间被诊断出来，并与癌症信息和人口健康资源的多付款人保险索赔相链接。县级数据来自罗伯特·伍德·约翰逊县健康排名数据库中多个公共来源的聚合。在五个领域中，量化了 8 个社会决定因素在县级层面的种族差距，并在 0-100 的最小-最大值范围内进行排名。将各领域的分数平均得出结构性种族主义综合指数（SRCI）分数。我们使用具有随机截距和多个交叉水平交互项的多层次逻辑回归来评估县级 SRCI 与患者层面治疗延迟之间的关联，同时调整患者层面的特征，并按种族分层。
SRCI 分数范围为 21 至 75，中位数（IQR）为 39.0（31.8，45.7）。对于黑人患者，SRCI 得分每增加 10 分，延迟的可能性就会增加（调整后的优势比[aOR]，1.25；95%置信区间[CL]，1.08 至 1.45）。白人患者则没有这种关联（OR，1.05；95%CL，0.97 至 1.15）。
用综合指数衡量的地区性 SR 与黑人患者 BC 治疗延迟的可能性增加有关，但与白人患者无关。县级 SR 水平的增加与治疗延迟的黑人和白人之间的差异增加有关。需要进一步研究来改进 SR 的衡量，并研究其与其他癌症护理差异的关联。
