Delgado D J, Lin W Y, Coffey M
Institute for Health Promotion and Disease Prevention Research, University of Southern California School of Medicine, Los Angeles 90033, USA.
P R Health Sci J. 1995 Jun;14(2):103-16.
The association of Hispanic race/ethnicity and poverty with general survival time and breast cancer survival time was examined for a total of 14,896 breast cancer patients (14,035 White and 861 Hispanic) included in the National Cancer Institute Surveillance Epidemiology and End Results (NCI SEER) program in New Mexico and San Francisco between 1975 and 1984. Variables examined included: age, marital status, stage at diagnosis, tumor histology, delay, treatment, period of diagnosis (1975-79 vs. 1980-84), and poverty. Univariate analysis of 14,896 patients indicated that a greater proportion of Hispanics (vs. Whites) with breast cancer were: younger than age 50, married, diagnosed at a later stage, diagnosed in New Mexico, lived in greater poverty, were diagnosed between 1980-84, and died from breast cancer. Univariate Cox Proportion Hazards analysis indicated that poverty was a significant predictor for reduced general survival time. Being diagnosed in the 1980-84 period was a predictor for improved general survival time. Poverty and Hispanic race/ethnicity were significant predictors of reduced breast cancer survival time. Multivariate Cox Proportional Hazards models indicated that Hispanic race/ethnicity was a significant risk factor for breast cancer survival time for women aged 50 and older. For White women: state, marital status, poverty, surgery, radiation/hormonal treatments, and histology were significant risk factors for breast cancer survival time. For Hispanic women: stage, surgery, hormonal treatment and period of diagnosis were significant risk factors for breast cancer survival time. For White breast cancer patients, period of diagnosis was not a significant risk factor for reduced breast cancer survival time; but for Hispanics, it was a significant risk factor. In the age and race/ethnicity-stratified models of breast cancer survival time, similar risk factors emerged for both Whites and Hispanics. For both younger and older Hispanics, being diagnosed in the early 1980's (vs. the late 1970's) was associated with reduced breast cancer survival time--vs. Whites, who experienced no significant change in breast cancer survival time in the same time period. Poverty was not a predictor for Hispanic survival time in any of the models; however, it was a predictor for younger Whites for breast cancer survival time. These results fueled discussion in three areas targeting breast cancer in underserved women: the development of racial/ethnic-specific cancer control guidelines, the development of a breast cancer integrated delivery system, and population management.
针对1975年至1984年间纳入美国国立癌症研究所监测、流行病学和最终结果（NCI SEER）项目的新墨西哥州和旧金山的14896名乳腺癌患者（14035名白人患者和861名西班牙裔患者），研究了西班牙裔种族/族裔及贫困状况与总体生存时间和乳腺癌生存时间之间的关联。所研究的变量包括：年龄、婚姻状况、诊断时的分期、肿瘤组织学、延误情况、治疗方式、诊断时期（1975 - 1979年与1980 - 1984年）以及贫困状况。对14896名患者进行的单因素分析表明，患有乳腺癌的西班牙裔患者（与白人患者相比）中更大比例的人具有以下特征：年龄小于50岁、已婚、诊断时处于较晚分期、在新墨西哥州被诊断、生活贫困程度更高、在1980 - 1984年期间被诊断以及死于乳腺癌。单因素Cox比例风险分析表明，贫困是总体生存时间缩短的一个显著预测因素。在1980 - 1984年期间被诊断是总体生存时间改善的一个预测因素。贫困和西班牙裔种族/族裔是乳腺癌生存时间缩短的显著预测因素。多因素Cox比例风险模型表明，西班牙裔种族/族裔是50岁及以上女性乳腺癌生存时间的一个显著风险因素。对于白人女性：所在州、婚姻状况、贫困状况、手术、放疗/激素治疗以及组织学是乳腺癌生存时间的显著风险因素。对于西班牙裔女性：分期、手术、激素治疗以及诊断时期是乳腺癌生存时间的显著风险因素。对于白人乳腺癌患者，诊断时期不是乳腺癌生存时间缩短的显著风险因素；但对于西班牙裔患者，它是一个显著风险因素。在乳腺癌生存时间的年龄和种族/族裔分层模型中，白人和西班牙裔出现了类似的风险因素。对于年轻和年长的西班牙裔患者，在20世纪80年代早期（与70年代晚期相比）被诊断与乳腺癌生存时间缩短相关——而白人在同一时期乳腺癌生存时间没有显著变化。在任何模型中，贫困都不是西班牙裔生存时间的预测因素；然而，它是年轻白人乳腺癌生存时间的一个预测因素。这些结果引发了针对医疗服务不足女性乳腺癌的三个领域的讨论：制定针对特定种族/族裔的癌症控制指南、开发乳腺癌综合服务体系以及人群管理。
