持续邻里贫困与乳腺癌结局

居住在社会经济条件较差社区的乳腺癌患者，常表现出较差的预后（例如，死亡率），与居住在贫困持续性较低的社区的个体相比。本研究旨在探讨持续性邻里贫困、乳腺肿瘤特征、手术治疗及死亡率之间的关系。采用回顾性队列分析方法，纳入2010年1月1日至2018年12月31日诊断为I至III期乳腺癌、且随访至2020年12月31日的女性≥18岁患者。数据来自监测、流行病学及最终结果（SEER）项目，数据分析于2023年8月至2024年3月进行。持续性贫困地区定义为约30年来20%以上人口生活在贫困线以下。主要结局为全因死亡和乳腺癌特异性死亡。研究共纳入312,145例患者（平均年龄[标准差]为61.9[13.3]岁），其中20,007例（6.4%）居住在持续贫困的统计区（CT）。与非持续贫困地区的患者相比，居住在持续贫困CT的患者更可能为黑人（8735/20007 [43.7%]对比 29588/292138 [10.1%]；P<.001）或西班牙裔（2605/20007 [13.0%]对比 23792/292138 [8.1%]；P<.001），且表现出更具侵袭性的肿瘤特征，包括更高分级疾病、三阴性乳腺癌及晚期肿瘤。居住在持续贫困地区的患者更倾向于接受乳房切除术及腋窝淋巴结清扫。居住在持续贫困CT与乳腺癌特异性（调整风险比[AHR] 1.10；95%置信区间[CI] 1.03-1.17）和全因死亡（AHR 1.13；95% CI 1.08-1.18）风险增加显著相关。诊断后仅3年，乳腺癌特异性（比率[RR] 1.80；95% CI 1.68-1.92）和全因死亡（RR 1.62；95% CI 1.56-1.70）风险即开始明显差异。本队列研究显示，居住在持续贫困社区的女性患者，其肿瘤特征、手术管理及死亡率均受影响。

Patients with breast cancer residing in socioeconomically disadvantaged communities often face poorer outcomes (eg, mortality) compared with individuals living in neighborhoods without persistent poverty.To examine persistent neighborhood poverty and breast tumor characteristics, surgical treatment, and mortality.A retrospective cohort analysis of women aged 18 years or older diagnosed with stage I to III breast cancer between January 1, 2010, and December 31, 2018, and followed up until December 31, 2020, was conducted. Data were obtained from the Surveillance, Epidemiology, and End Results Program, and data analysis was performed from August 2023 to March 2024.Residence in areas affected by persistent poverty is defined as a condition where 20% or more of the population has lived below the poverty level for approximately 30 years.All-cause and breast cancer-specific mortality.Among 312 145 patients (mean [SD] age, 61.9 [13.3] years), 20 007 (6.4%) lived in a CT with persistent poverty. Compared with individuals living in areas without persistent poverty, patients residing in persistently impoverished CTs were more likely to identify as Black (8735 of 20 007 [43.7%] vs 29 588 of 292 138 [10.1%]; P < .001) or Hispanic (2605 of 20 007 [13.0%] vs 23 792 of 292 138 [8.1%]; P < .001), and present with more-aggressive tumor characteristics, including higher grade disease, triple-negative breast cancer, and advanced stage. A higher proportion of patients residing in areas with persistent poverty underwent mastectomy and axillary lymph node dissection. Living in a persistently impoverished CT was associated with a higher risk of breast cancer-specific (adjusted hazard ratio [AHR], 1.10; 95% CI, 1.03-1.17) and all-cause (AHR, 1.13; 95% CI, 1.08-1.18) mortality. As early as 3 years following diagnosis, mortality risks diverged for both breast cancer-specific (rate ratio [RR], 1.80; 95% CI, 1.68-1.92) and all-cause (RR, 1.62; 95% CI, 1.56-1.70) mortality.In this cohort study of women aged 18 years or older diagnosed with stage I to III breast cancer between 2010 and 2018, living in neighborhoods characterized by persistent poverty had implications on tumor characteristics, surgical management, and mortality.