Hill H A, Eley J W, Harlan L C, Greenberg R S, Barrett R J, Chen V W
Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, Georgia, USA.
Obstet Gynecol. 1996 Dec;88(6):919-26. doi: 10.1016/s0029-7844(96)00341-9.
To identify factors that explain a lower survival rate among black women with endometrial cancer when compared to white women.
Data are from the National Cancer Institute's Black/White Cancer Survival Study, a population-based study of racial differences in cancer survival. Subjects included 329 white and 130 black women, ages 20-79 years, residing in the metropolitan areas of Atlanta, New Orleans, or San Francisco-Oakland, diagnosed with endometrial cancer from 1985 to 1987. Known prognostic factors were assessed as potential explanatory variables for the black-white survival difference using proportional hazards regression. Information was derived from interviews, abstracts of hospital and physicians' records, and a centralized review of biopsy and surgical specimens.
Adjusting for age and geographic location, risk of death among black women was 4.0 times (95% confidence interval [CI] 2.8, 5.6) that of white women. Approximately 40% of this difference could be attributed to a more advanced stage at diagnosis among black women, and 23% to tumor characteristics and treatment. Further adjustment for all remaining factors reduced the hazard ratio to 1.6 (95% CI 1.0, 2.6).
Eighty percent of the excess mortality among black women is explained by racial differences in stage at diagnosis, tumor characteristics, treatment, sociodemographic characteristics, hormonal and reproductive factors, and factors related to comorbidities and health behavior. Difference in stage at diagnosis is prominent in explaining the disparity in endometrial cancer survival rates in black and white women. Potential differences in treatment within stage merit further exploration.
确定与白人女性相比，子宫内膜癌黑人女性生存率较低的解释因素。
数据来自美国国家癌症研究所的黑/白癌症生存研究，这是一项基于人群的癌症生存种族差异研究。研究对象包括329名白人女性和130名黑人女性，年龄在20 - 79岁之间，居住在亚特兰大、新奥尔良或旧金山 - 奥克兰的大都市地区，于1985年至1987年被诊断为子宫内膜癌。使用比例风险回归评估已知的预后因素作为黑 - 白生存差异的潜在解释变量。信息来源于访谈、医院和医生记录摘要以及活检和手术标本的集中审查。
在调整年龄和地理位置后，黑人女性的死亡风险是白人女性的4.0倍（95%置信区间[CI] 2.8, 5.6）。这种差异中约40%可归因于黑人女性诊断时疾病分期更晚，23%可归因于肿瘤特征和治疗。对所有其余因素进行进一步调整后，风险比降至1.6（95% CI 1.0, 2.6）。
黑人女性额外死亡率的80%可由诊断时的分期、肿瘤特征、治疗、社会人口学特征、激素和生殖因素以及与合并症和健康行为相关的因素方面的种族差异来解释。诊断时的分期差异在解释黑人和白人女性子宫内膜癌生存率差异方面尤为突出。同一分期内治疗的潜在差异值得进一步探索。
