New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.
Cancer Med. 2024 Aug;13(16):e70071. doi: 10.1002/cam4.70071.
There are well-documented racial and ethnic disparities in mortality after cancer in the general population, but less is known about whether disparities also exist in disaster-exposed populations.
We conducted a longitudinal cohort study of 4341 enrollees in the World Trade Center Health Registry (WTCHR) with a first-ever primary invasive cancer diagnosis after 9/11/2001 and followed through 2020. We examined associations of race and ethnicity with all-cause mortality risk and cause-specific mortality risk using multivariable Cox proportional hazards regression models and Fine and Gray's proportional sub-distribution hazards models, respectively. Models were adjusted for baseline characteristics and tumor characteristics. We also examined models further adjusted for socioeconomic status (SES), and we used inverse odds weighting to formally test for mediation by SES.
Compared to non-Hispanic White enrollees with cancer, non-Hispanic Blacks had higher risks for all-cause mortality (adjusted hazard ratio (aHR) = 1.20, 95% CI = 1.02-1.41) and non-cancer mortality (aHR = 1.48, 95% CI = 1.09-2.01) in the full model. In the model without SES, Hispanic enrollees with cancer had higher risks for all-cause mortality (aHR = 1.32, 95% CI = 1.09-1.60) and cancer mortality (aHR = 1.31, 95% CI = 1.05-1.64) compared to non-Hispanic Whites; these associations became not statistically significant in the full model. In the inverse odds weighting analysis, SES explained 24% and 29% of the disparity in all-cause mortality risk observed in non-Hispanic Blacks and Hispanics, respectively, compared to non-Hispanic Whites.
This study found that there are racial and ethnic disparities in mortality after cancer in the WTCHR. Additional studies are needed to further explore the factors mediating these disparities.
在普通人群中，癌症后死亡率存在明显的种族和民族差异，但对于受灾人群中是否也存在差异知之甚少。
我们对参加世界贸易中心健康登记处（WTCHR）的 4341 名参与者进行了一项纵向队列研究，这些参与者在 2001 年 9 月 11 日后首次被诊断出原发性侵袭性癌症，并随访至 2020 年。我们使用多变量 Cox 比例风险回归模型和 Fine 和 Gray 的比例亚分布风险模型分别检查了种族和民族与全因死亡率风险和特定原因死亡率风险之间的关联。模型调整了基线特征和肿瘤特征。我们还进一步检查了调整社会经济地位（SES）的模型，并使用逆概率加权法正式检验 SES 的中介作用。
与癌症的非西班牙裔白种人登记者相比，非西班牙裔黑种人全因死亡率（调整后的危险比（aHR）=1.20，95%可信区间（CI）=1.02-1.41）和非癌症死亡率（aHR=1.48，95%CI=1.09-2.01）的风险更高在全模型中。在没有 SES 的模型中，癌症的西班牙裔登记者全因死亡率（aHR=1.32，95%CI=1.09-1.60）和癌症死亡率（aHR=1.31，95%CI=1.05-1.64）的风险高于非西班牙裔白人；这些关联在全模型中不再具有统计学意义。在逆概率加权分析中，SES 分别解释了非西班牙裔黑人和西班牙裔与非西班牙裔白人相比，全因死亡率风险差异的 24%和 29%。
这项研究发现，WTCHR 中癌症后死亡率存在种族和民族差异。需要进一步研究来进一步探讨这些差异的中介因素。
