There are many racial and ethnic disparities in cancer outcomes. Through special studies supported by CDC, we found that compared with Caucasians, African-American women with breast cancer were more likely to have cancer recurrences. We are interested in exploring this racial disparity by identifying risk factors that contribute to the disparity and quantify their effects. Cancer may recur after a disease-free (cancer cannot be detected) period. In exploring cancer recurrences, it is important to take into account competing events, for example, a patient died of cancer but never had a disease-free period. We propose the use of the Fine-Gray model in the multiple third-variable analysis to explore the racial disparity. The challenges were that we have to deal with left-truncated and right-censored data and use different weights in the third-variable analysis when exploring different distributions of risk factors among different racial populations. We propose an algorithm for the analysis and apply the method to explore the racial disparity in cancer recurrence on breast cancer patients diagnosed in 2011 in Louisiana. The racial disparity in breast cancer recurrence was partially explained by the tumour characteristics at the time of diagnosis, cancer subtypes and treatment, and the patients' residential environmental conditions. We are able to explain 50% of the disparity. The method is implemented in the R package mma.

中文翻译：

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竞争风险数据的多第三变量分析——应用探索乳腺癌复发中的种族差异

癌症结果存在许多种族和民族差异。通过疾病预防控制中心支持的专项研究，我们发现与白种人相比，患有乳腺癌的非裔美国女性更容易出现癌症复发。我们有兴趣通过确定导致差异的风险因素并量化其影响来探索这种种族差异。癌症可能会在无病（无法检测到癌症）期后复发。在探索癌症复发时，重要的是要考虑到竞争事件，例如，一名患者死于癌症但从未有过无病期。我们建议在多个第三变量分析中使用 Fine-Gray 模型来探索种族差异。挑战在于，在探索不同种族人群中风险因素的不同分布时，我们必须处理左截断和右截尾数据，并在第三变量分析中使用不同的权重。我们提出了一种分析算法，并应用该方法探索路易斯安那州 2011 年诊断出的乳腺癌患者癌症复发的种族差异。诊断时的肿瘤特征、癌症亚型和治疗以及患者的居住环境条件可以部分解释乳腺癌复发的种族差异。我们能够解释 50% 的差异。该方法在R包中实现 我们提出了一种分析算法，并应用该方法探索路易斯安那州 2011 年诊断出的乳腺癌患者癌症复发的种族差异。诊断时的肿瘤特征、癌症亚型和治疗以及患者的居住环境条件可以部分解释乳腺癌复发的种族差异。我们能够解释 50% 的差异。该方法在R包中实现 我们提出了一种分析算法，并应用该方法探索路易斯安那州 2011 年诊断出的乳腺癌患者癌症复发的种族差异。诊断时的肿瘤特征、癌症亚型和治疗以及患者的居住环境条件可以部分解释乳腺癌复发的种族差异。我们能够解释 50% 的差异。该方法在R包中实现 我们能够解释 50% 的差异。该方法在R包中实现 我们能够解释 50% 的差异。该方法在R包中实现嗯。