PO.PR01.01 · 预防研究
驱动年轻黑人与白人患者结直肠癌死亡率差异的社会决定因素与生活方式因素
Social determinants and lifestyle factors driving colorectal cancer mortality disparities in younger Black and White patients
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
背景：黑人与白人患者相比，结直肠癌（CRC）死亡率的差异在较年轻年龄段更为明显。新兴数据表明，黑人诊断年龄较早与吸烟、饮酒等社会经济和生活方式因素相关；然而，这些因素是否导致了种族和年龄特异性CRC死亡率的差异仍不明确。
方法：本研究使用南卡罗来纳医科大学（MUSC）Hollings癌症中心癌症登记处的数据，识别2000—2021年间随访≥12个月的可分析CRC病例。本研究经MUSC机构审查委员会批准。采用Cox比例风险回归估计黑人与白人患者的死亡风险（HR，[95% CI]），并校正年龄、性别、分期、诊断年份和治疗。评估的交互作用包括：种族×年龄（连续变量）、种族×社会剥夺指数（SVI，高vs低）、种族×饮酒（当前vs非）、种族×吸烟（当前vs非）。
结果：在1,324例患者中，43.5%为女性，31.7%为黑人。中位年龄62岁；黑人为60岁，白人为63岁。黑人中位生存期为68个月，白人为95个月。黑人的校正死亡风险更高（1.19 [1.01-1.40] vs 白人）。种族与年龄之间存在显著交互作用（p=0.01）：<65岁的黑人较白人死亡率更高（HR 1.38 [1.10-1.69]），而≥65岁者未观察到种族差异（HR 0.99 [0.76-1.28]）。我们观察到种族与SVI之间存在显著交互作用（p=0.04）：在SVI较高者中，黑人患者死亡风险略有下降（HR 0.88 [0.66-1.16]），而白人风险升高（HR 1.24 [1.02-1.49]）；这一差异仅限于<65岁者。种族与饮酒之间也存在显著交互作用（p=0.0001）：当前饮酒的黑人死亡风险升高（HR 1.63 [1.20-2.22]），而白人风险较低（HR 0.82 [0.67-1.00]），同样仅限于<65岁患者。当前吸烟使黑人（HR 1.70 [1.23-2.35]）和白人（HR 1.33 [1.05-1.67]）的死亡风险均升高，种族×吸烟无显著交互作用（p=0.22），也无年龄特异性效应。曾经吸烟或曾经饮酒得出类似但减弱的结果。死亡风险不因性别而异。
结论：<65岁的黑人CRC患者较白人死亡风险更高，尤其是当前饮酒者以及同时吸烟/饮酒者。≥65岁者未观察到种族差异。SVI较高（更脆弱）的年轻黑人较SVI相似的白人死亡率更低，提示较贫困黑人社区中卫生服务的可及性改善了结局。这些发现识别出一个特别脆弱的亚人群，他们可能受益于以改善医疗可及性、消除社会障碍以及加强吸烟和饮酒筛查为重点的针对性干预。
查看英文原文 English abstract
Background : Disparities in colorectal cancer (CRC) mortality in Black compared to White patients are more evident at younger ages. Emerging data suggests that earlier age of diagnosis in Blacks is associated with socioeconomic and lifestyle factors such as smoking and alcohol use; however, whether these factors contribute to differences in race- and age-specific CRC mortality remains unclear.
Methods : Data from the Medical University of South Carolina (MUSC) Hollings Cancer Center cancer registry was used to identify analytic CRC cases from 2000 - 2021 with ≥12 months of follow-up. This study was approved by the MUSC Institutional Review Board. Cox proportional hazards regression estimated risk of death (HR, [95% CI]) for Black versus White patients adjusting for age, sex, stage, year of diagnosis, and treatment. Interactions assessed were race x age (continuous), race x social deprivation index (SVI, high vs low), race x alcohol use (current vs not), race x smoking (current vs not).
Results : Of 1,324 patients, 43.5% were female, and 31.7% Black. Median age 62 years; 60 years for Black, 63 years for White. Median survival of 68 months for Blacks and 95 months for Whites. Blacks had higher adjusted risk of death (1.19 [1.01-1.40] vs Whites). There was significant interaction for race by age (p=0.01): Blacks <65 years had greater mortality than Whites (HR 1.38 [1.10-1.69]), with no racial difference observed for those ≥65 years (HR 0.99 [0.76-1.28]). We observed a significant race by SVI interaction (p=0.04): among those with higher SVI, Black patients had modest decrease in risk of death (HR 0.88 [0.66-1.16]) whereas Whites had an increased risk (HR 1.24 [1.02-1.49]); this difference was confined to those <65 years. A significant race by alcohol interaction was also present (p=0.0001): current drinkers who were Black had an increased risk of death (HR 1.63 [1.20-2.22]), while those who were White had a lower risk (HR 0.82 [0.67-1.00]), again limited to patients <65 years. Current smoking increased risk of death in both Blacks (HR 1.70 [1.23-2.35]) and Whites (HR 1.33 [1.05-1.67]), with no significant race x smoking interaction (p=0.22) or age-specific effect. Ever smoking or ever drinking yielded similar but attenuated results. Mortality risk did not differ by sex.
Conclusion : Black CRC patients <65 years had higher mortality risk than Whites, and specifically those with current alcohol use and concurrent smoking/alcohol use. No racial difference observed for those ≥65 years. Younger Black people with higher SVI (more vulnerability) had lower mortality than Whites with similar SVI, suggesting that access to health services in poorer Black communities improves outcomes. These findings identify a particularly vulnerable subpopulation that may benefit from targeted interventions focused on improving care access, addressing social barriers, and enhancing smoking and alcohol screening
利益披露 Disclosure
C. M. Okafor, None..
T. L. Crawford, None..
J. Pearce, None..
K. Williams, None..
A. V. Alekseyenko, None.