种族/族裔在肯塔基州乳腺癌患者（2010 - 2022年）邻里贫困与乳腺癌预后关联中的作用
The Role of Race/Ethnicity on the Association between Neighborhood Deprivation and Breast Cancer Outcomes among Kentucky Patients with Breast Cancer (2010-2022).
作者信息
Walker Breyanna, Pollard Elinita, Howard Sydney P, Jones V Morgan, O'Connor Kathleen L, Durbin Eric B, Hull Pamela C, Jones Samantha R, Adegboyega Adebola, Wang Xiaoqin, Owen Wendi A B, Szabunio Margaret M, Williams Lovoria B, Moore Justin X
机构信息
Markey Cancer Center, University of Kentucky, Lexington, Kentucky.
Center for Health Equity Transformation, University of Kentucky, Lexington, Kentucky.
出版信息
Cancer Epidemiol Biomarkers Prev. 2025 Apr 3;34(4):474-482. doi: 10.1158/1055-9965.EPI-24-1139.
BACKGROUND
Kentucky is within the top five leading states for breast cancer mortality nationwide. This study investigates the association between neighborhood socioeconomic disadvantage and breast cancer outcomes, including surgical treatment, radiotherapy, chemotherapy, and survival, and how associations vary by race and ethnicity in Kentucky.
METHODS
We conducted a retrospective cohort analysis using data from the Kentucky Cancer Registry for patients with breast cancer diagnosed between 2010 and 2017, with follow-up through December 31, 2022. We linked Kentucky Cancer Registry data with census tract data to examine the relationship between area deprivation index (ADI) and breast cancer outcomes. Logistic regression and Cox proportional hazards models analyzed binary outcomes and time-to-event data, respectively.
RESULTS
Women in the most disadvantaged (ADI fourth quartile) neighborhoods were more likely to be diagnosed at later stages (OR, 1.26; 95% confidence interval, 1.12-1.41) and 34% more likely to die from breast cancer (HR, 1.34; 95% confidence interval, 1.14-1.57) after adjusting for age, race, tobacco use, tobacco pack-years, marital status, insurance status, family history, stage at diagnosis, breast cancer subtype, and residence in Appalachia when compared with women living in the least disadvantaged neighborhoods (ADI first quartile).
CONCLUSIONS
Women in disadvantaged neighborhoods had significantly higher odds of late-stage diagnosis and breast cancer death, regardless of race, indicating that neighborhood factors contribute to breast cancer disparities.
IMPACT
Socioeconomic and neighborhood factors may contribute to breast cancer outcomes, suggesting the necessity for targeted interventions. Future research should explore the effectiveness of such interventions and investigate additional social determinants contributing to disparities.
背景
肯塔基州是全美乳腺癌死亡率最高的五个州之一。本研究调查了社区社会经济劣势与乳腺癌治疗结果之间的关联，包括手术治疗、放疗、化疗和生存率，以及这些关联在肯塔基州如何因种族和族裔而异。
方法
我们进行了一项回顾性队列分析，使用肯塔基州癌症登记处2010年至2017年期间诊断为乳腺癌患者的数据，并随访至2022年12月31日。我们将肯塔基州癌症登记处的数据与人口普查区数据相链接，以研究地区贫困指数（ADI）与乳腺癌治疗结果之间的关系。逻辑回归和Cox比例风险模型分别分析二元结果和事件发生时间数据。
结果
在调整年龄、种族、吸烟情况、吸烟包年数、婚姻状况、保险状况、家族病史、诊断分期、乳腺癌亚型以及是否居住在阿巴拉契亚地区后，与居住在最不贫困社区（ADI第一四分位数）的女性相比，居住在最贫困社区（ADI第四四分位数）的女性更有可能在晚期被诊断出乳腺癌（比值比，1.26；95%置信区间，1.12 - 1.41），死于乳腺癌的可能性高34%（风险比，1.34；95%置信区间，1.14 - 1.57）。
结论
无论种族如何，贫困社区的女性晚期诊断和乳腺癌死亡几率显著更高，这表明社区因素导致了乳腺癌差异。
影响
社会经济和社区因素可能导致乳腺癌治疗结果不同，这表明有必要进行有针对性的干预。未来的研究应探索此类干预措施的有效性，并调查导致差异的其他社会决定因素。
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