在美国,邻里处于不利地位和乳腺癌特定的生存率
Neha Goel1,2,3, Alexandra E Hernandez1,2, Angela Mazul4,5,6
1Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, Florida.
JAMA network open
|April 18, 2024
概括
邻里处于不利地位与更糟糕的乳腺癌存活率有关,即使考虑到患者和治疗因素. 这凸显了需要解决社会经济和环境对癌症结果的影响.
科学领域:
- 在瘤学瘤学.
- 公共卫生 公共卫生
- 健康的社会经济决定因素
背景情况:
- 乳腺癌的生存率有所提高,但仍然存在显著的差异,特别是影响贫困社区的居民.
- 现有的研究往往将这些差异归因于个体,瘤和治疗特征,从而在理解社区层面的影响方面留下了一个差距.
- 社区社会经济地位对乳腺癌结果的影响需要进一步调查.
研究的目的:
- 为了确定邻居的劣势是否独立地与乳腺癌特定存活率的降低有关.
- 在对关键个体,瘤和治疗变量进行控制后,在国家队列中分析这一关联.
- 确定乳腺癌存活率差异的潜在社会经济驱动因素.
主要方法:
- 采用监测,流行病学和最终结果 (SEER) 数据库 (2013-2018) 进行的国家回顾性队列研究.
- 使用Yost指数五分位数量化邻居的劣势.
- 乳腺癌特异性存活率使用竞争性风险因果特异性危险模型进行评估,并根据人口,临床和治疗因素进行调整.
主要成果:
- 该研究包括350,824名患有乳腺癌的患者.
- 居住在最贫困地区 (五分之一) 的患者与居住在最贫困地区 (五分之一) 的患者相比,患乳腺癌的死亡风险明显高 (危险比:1.43;95% CI:1.36-1.50).
- 弱势社区的非西班牙裔黑人和西班牙裔患者比例较高,而优势社区主要由非西班牙裔白人患者居住.
结论:
- 邻里处于不利地位是短暂的乳腺癌特异性生存率的独立预测因素.
- 这些发现表明,超出个人,瘤和治疗特征的因素有助于生存差异.
- 进一步的研究应该探索与邻里处于不利地位和乳腺癌结果相关的非生物和生物机制.
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