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Neighborhood context and non-small cell lung cancer outcomes in Florida non-elderly patients by race/ethnicity.
Lung Cancer ( IF 5.3 ) Pub Date : 2020-01-16 , DOI: 10.1016/j.lungcan.2020.01.012
Asal M Johnson 1 , Allen Johnson 2 , Robert B Hines 3 , Raheleh Mohammadi 2
Affiliation  

OBJECTIVE The purpose of this study was to investigate the relationship between neighborhood environment and lung cancer outcomes among Florida residents younger than 65 years of age. METHODS AND MATERIALS This was a retrospective cohort study that included patients diagnosed with non-small cell lung cancer (NSCLC) in Florida from January 2005 to December 2014 (n = 22,750). Multi-level, mixed-effect logistic regression models were used for two outcomes: receipt of treatment and receipt of surgery. Survival analyses, using proportional subdistribution hazard models, were conducted to examine the impact of neighborhood characteristics on risk of death due to lung cancer with adjustment for individual-level variables. Neighborhood exposures of interest were census tract level black and Hispanic segregation combined with economic deprivation. RESULTS White patients who lived in low black segregation/high deprivation areas had 15 % lower odds of receiving surgery (95 % CI: 0.76-0.93). However, the likelihood of receiving surgery for black patients who lived in high black segregation/low deprivation and high black segregation/high deprivation was lower than for black patients who lived in low black segregation/low deprivation neighborhoods (level 3 AOR = 0.56 [0.38-0.85]; level 4 AOR = 0.69 [0.54-0.88]). Living in suburban and rural areas increased the risk of lung cancer death for white patients by 14 % (95 % CI: 1.05-1.24) and 26 % (95 % CI: 1.08-1.46), respectively. Living in rural areas increased the risk of death for black patients by 54 % r (SHR = 1.54 [1.19-2.0]). Black patients who live in high Hispanic segregation/high deprivation had 36 % increased risk of death compared to black patients who lived in low Hispanic segregation/low deprivation areas. CONCLUSION This study suggests that when investigating cancer disparities, merely adjusting for race/ethnicity does not provide sufficient explanation to understand survival and treatment variations. Lung cancer outcomes are impacted by neighborhood environments that are formed based on the distribution of race, ethnicity and class.

中文翻译:

按种族/民族划分的佛罗里达州非老年患者的邻里背景和非小细胞肺癌结局。

目的本研究的目的是调查65岁以下的佛罗里达州居民的社区环境与肺癌结局之间的关系。方法和材料这是一项回顾性队列研究,纳入了2005年1月至2014年12月在佛罗里达州诊断为非小细胞肺癌(NSCLC)的患者(n = 22,750)。多级,混合效应逻辑回归模型用于两个结果:接受治疗和接受手术。使用比例子分布风险模型进行生存分析,通过调整个体水平变量来研究邻域特征对肺癌死亡风险的影响。邻里感兴趣的人口普查区域为黑色,西班牙裔隔离加上经济匮乏。结果居住在低黑人隔离/高贫困地区的白人患者接受手术的几率降低了15%(95%CI:0.76-0.93)。但是,居住在高黑人隔离/低贫困和高黑人隔离/高贫困的黑人患者接受手术的可能性低于居住在低黑人隔离/低贫困邻里的黑人患者(3 AOR = 0.56 [0.38 -0.85];级别4 AOR = 0.69 [0.54-0.88])。居住在郊区和农村地区的白人患者肺癌死亡风险分别增加了14%(95%CI:1.05-1.24)和26%(95%CI:1.08-1.46)。生活在农村地区使黑人患者的死亡风险增加了54%r(SHR = 1.54 [1.19-2.0])。与居住在低西班牙裔隔离/低贫困地区的黑人患者相比,居住在西班牙裔高隔离/高贫困地区的黑人患者的死亡风险增加了36%。结论该研究表明,在调查癌症差异时,仅针对种族/民族进行调整并不能提供足够的解释来了解生存率和治疗差异。肺癌的结局受到基于种族,种族和阶级分布形成的邻里环境的影响。
更新日期:2020-01-17
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