PO.PS01.04 · 人群科学
美国确诊导管原位癌女性中心血管疾病死亡率的种族和族裔差异
Racial and ethnic differences in cardiovascular disease mortality among women diagnosed with ductal carcinoma in situ in the United States
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摘要 Abstract
中文摘要
背景：导管原位癌（DCIS）与心血管疾病（CVD）死亡风险升高相关，这可能归因于合并症或癌症治疗，然而既往考察种族和族裔差异的研究有限。本研究旨在探讨美国确诊DCIS女性中种族、族裔与CVD死亡率之间的关联。
方法：我们纳入2000至2017年间在美国监测、流行病学和最终结果（SEER）数据库中确诊为首个原发DCIS、年龄20-84岁的女性，随访超过一年。采用Fine和Gray回归估计按种族和族裔（西班牙裔、非西班牙裔亚裔美国人（NH-AA）、NH-黑人、NH-夏威夷原住民及其他太平洋岛民（NH-NHPI）和NH-白人）的CVD死亡亚分布风险比（HR），校正诊断时年龄、诊断年份、手术类型和放疗，并考虑非CVD死亡的竞争风险。模型进一步按DCIS诊断年龄（<50岁和≥50岁）和年份（2000-2004、2005-2009和2010-2017）分层。同时评估了按种族和族裔的CVD死亡累积发病率，并考虑竞争风险。
结果：在158,072名确诊DCIS的女性中（中位随访=6.80年；平均年龄=58.47岁），共识别出4,504例CVD死亡（3,190例心脏病、964例脑血管疾病和350例其他CVD死亡）。与NH-白人女性相比，NH-黑人和NH-NHPI女性CVD死亡风险更高（HR NH-黑人=1.61，95% CI=1.48-1.76；HR NH-NHPI=1.80，95% CI=1.22-2.65），而NH-AA女性CVD死亡风险更低（HR NH-AA=0.68，95% CI=0.60-0.79）。与NH-白人女性相比，西班牙裔女性的CVD死亡无显著关联（HR 西班牙裔=0.91，95% CI=0.80-1.03）。尽管无论DCIS诊断时年龄如何，NH-黑人和NH-NHPI女性的CVD死亡风险升高依然更高，但在分层分析中，较年轻女性（<50岁）相比较年长女性（≥50岁）具有更大的相对风险（HR NH-黑人，<50=3.93，95% CI=2.62-5.90，HR NH-黑人，≥50=1.56，95% CI=1.43-1.71；HR NH-NHPI，<50=4.19，95% CI=1.04-16.97，HR NH-NHPI，≥50=1.73，95% CI=1.16-2.59）。CVD死亡风险随诊断年份增加，尤其在NH-黑人和NH-NHPI女性中。NH-黑人和NH-NHPI女性在DCIS诊断后5年（分别为1.51%，95% CI=1.33%-1.72%和1.53%，95% CI=0.81%-2.66%）和10年（分别为4.29%，95% CI=3.90%-4.70%和4.17%，95% CI=2.62%-6.26%）的CVD死亡累积发病率最高。
结论：确诊DCIS的NH-黑人和NH-NHPI女性相比NH-白人女性具有更高的CVD死亡率，尤其在较年轻女性和近年确诊者中。需要进一步研究以理解驱动NH-黑人和NH-NHPI DCIS女性CVD死亡风险升高的多层次因素。
查看英文原文 English abstract
Background: Ductal carcinoma in situ (DCIS) is associated with an elevated risk of cardiovascular disease (CVD) mortality, which may be due to comorbidities or cancer treatment, yet prior studies examining racial and ethnic differences are limited. The aim of this study is to investigate the association between race, ethnicity and CVD mortality among women diagnosed with DCIS in the United States.
Methods: We included women diagnosed with a first primary DCIS aged 20-84 between 2000 to 2017 in the U.S. Surveillance, Epidemiology, and End Results, and followed for more than one year. Fine and Gray regression was used to estimate sub-distribution hazard ratios (HRs) for CVD mortality by race and ethnicity (Hispanic, non-Hispanic Asian American (NH-AA), NH-Black, NH-Native Hawaiian and other Pacific Islander (NH-NHPI), and NH-White), adjusting for age at diagnosis, year of diagnosis, surgery type, and radiotherapy, and accounting for competing risks of non-CVD death. Models were further stratified by DCIS diagnosis age (<50 and ≥ 50) and year (2000-2004, 2005-2009, and 2010-2017). Cumulative incidence of CVD mortality was also assessed by race and ethnicity, accounting for competing risks.
Results: Among 158,072 women diagnosed with DCIS (median follow-up=6.80 years; mean age=58.47 years), 4,504 CVD deaths were identified (3,190 heart disease, 964 cerebrovascular disease, and 350 other CVD deaths). Compared to NH-White women, NH-Black and NH-NHPI women had a higher risk of CVD mortality (HR NH-Black = 1.61, 95%CI=1.48-1.76; HR NH-NHPI = 1.80, 95%CI=1.22-2.65) while NH-AA women had a lower risk of CVD mortality (HR NH-AA = 0.68, 95%CI=0.60-0.79). There was no significant association of CVD mortality for Hispanic women compared NH-White women (HR Hispanic = 0.91, 95%CI=0.80-1.03). Although the increased risk of CVD mortality remained higher in NH-Black and NH-NHPI women regardless of age at DCIS diagnosis, younger women (<50 years) had greater relative risk compared to older women (≥50 years) in stratified analyses (HR NH-Black, <50 = 3.93, 95%CI=2.62-5.90, HR NH-Black, ≥50 = 1.56, 95%CI=1.43-1.71; HR NH-NHPI,<50 = 4.19, 95%CI=1.04-16.97, HR NH-NHPI, ≥50 = 1.73, 95%CI=1.16-2.59). Risk of CVD mortality increased by year of diagnosis, especially among NH-Black and NH-NHPI women. NH-Black and NH-NHPI women had the highest cumulative incidence of CVD mortality at 5-years (1.51%, 95%CI=1.33%-1.72% and 1.53% 95%CI=0.81%-2.66% respectively) and 10-years (4.29%, 95%CI=3.90%-4.70% and 4.17% 95%CI=2.62%-6.26% respectively) post DCIS diagnosis.
Conclusions: NH-Black and NH-NHPI women diagnosed with DCIS had higher CVD mortality compared to NH-White women, especially among younger women and those diagnosed in recent years. Further studies are needed to understand multi-level factors driving the increased risk of CVD mortality in NH-Black and NH-NHPI women with DCIS.
利益披露 Disclosure
Y. Pan, None..
Z. Zakaria, None..
J. Li, None..
L. H. Viega, None..
A. Berrington de Gonzalez, None..
G. Datta, None..
J. B. Vo, None..
C. Ramin, None.