PDF(Pubmed)
Abstract：
Significant demographic disparities have been found to exist in the delivery of health care. Demographic factors associated with clinical decision-making in kidney cancer have not been thoroughly studied.
To determine whether demographic factors, including sex and race/ethnicity, are associated with receipt of non-guideline-based treatment for kidney cancer.
This retrospective cohort study was conducted using data from the National Cancer Database for the years 2010 through 2017. Included patients were individuals aged 30 to 70 years with localized (ie, cT1-2, N0, M0) kidney cancer and no major medical comorbidities (ie, Charlson-Deyo Comorbidity Index score of 0 or 1) treated at Commission on Cancer-accredited health care institutions in the United States. Data were analyzed from November 2020 through March 2021.
Demographic factors, including sex, race/ethnicity, and insurance status.
Receipt of non-guideline-based treatment (undertreatment or overtreatment) for kidney cancer, as defined by accepted clinical guidelines, was determined.
Among 158 445 patients treated for localized kidney cancer, 99 563 (62.8%) were men, 120 001 individuals (75.7%) were White, and 91 218 individuals (57.6%) had private insurance. The median (interquartile range) age was 58 (50-64) years. Of the study population, 48 544 individuals (30.6%) received non-guideline-based treatment. Female sex was associated with lower adjusted odds of undertreatment (odds ratio [OR], 0.82; 95% CI, 0.77-0.88; P < .001) and higher adjusted odds of overtreatment (OR, 1.27; 95% CI, 1.24-1.30; P < .001) compared with male sex. Compared with White patients, Black and Hispanic patients had higher adjusted odds of undertreatment (Black patients: OR, 1.42; 95% CI, 1.29-1.55; P < .001; Hispanic patients: OR, 1.20; 95% CI, 1.06-1.36; P = .004) and overtreatment (Black patients: OR, 1.09; 95% CI, 1.05-1.13; P < .001; Hispanic patients: OR, 1.06; 95% CI, 1.01-1.11, P = .01). Individuals who were uninsured, compared with those who had insurance, had statistically significantly higher adjusted odds of undertreatment (OR, 2.63; 95% CI, 2.29-3.01; P < .001) and lower adjusted odds of overtreatment (OR, 0.72; 95% CI, 0.67-0.77; P < .001).
This study found that there were significant disparities in treatment decision-making for patients with kidney cancer, with increased rates of non-guideline-based treatment for women and Black and Hispanic patients. These findings suggest that further research into the mechanisms underlying these disparities is warranted and that clinical and policy decision-making should take these disparities into account.
To determine whether demographic factors, including sex and race/ethnicity, are associated with receipt of non-guideline-based treatment for kidney cancer.
This retrospective cohort study was conducted using data from the National Cancer Database for the years 2010 through 2017. Included patients were individuals aged 30 to 70 years with localized (ie, cT1-2, N0, M0) kidney cancer and no major medical comorbidities (ie, Charlson-Deyo Comorbidity Index score of 0 or 1) treated at Commission on Cancer-accredited health care institutions in the United States. Data were analyzed from November 2020 through March 2021.
Demographic factors, including sex, race/ethnicity, and insurance status.
Receipt of non-guideline-based treatment (undertreatment or overtreatment) for kidney cancer, as defined by accepted clinical guidelines, was determined.
Among 158 445 patients treated for localized kidney cancer, 99 563 (62.8%) were men, 120 001 individuals (75.7%) were White, and 91 218 individuals (57.6%) had private insurance. The median (interquartile range) age was 58 (50-64) years. Of the study population, 48 544 individuals (30.6%) received non-guideline-based treatment. Female sex was associated with lower adjusted odds of undertreatment (odds ratio [OR], 0.82; 95% CI, 0.77-0.88; P < .001) and higher adjusted odds of overtreatment (OR, 1.27; 95% CI, 1.24-1.30; P < .001) compared with male sex. Compared with White patients, Black and Hispanic patients had higher adjusted odds of undertreatment (Black patients: OR, 1.42; 95% CI, 1.29-1.55; P < .001; Hispanic patients: OR, 1.20; 95% CI, 1.06-1.36; P = .004) and overtreatment (Black patients: OR, 1.09; 95% CI, 1.05-1.13; P < .001; Hispanic patients: OR, 1.06; 95% CI, 1.01-1.11, P = .01). Individuals who were uninsured, compared with those who had insurance, had statistically significantly higher adjusted odds of undertreatment (OR, 2.63; 95% CI, 2.29-3.01; P < .001) and lower adjusted odds of overtreatment (OR, 0.72; 95% CI, 0.67-0.77; P < .001).
This study found that there were significant disparities in treatment decision-making for patients with kidney cancer, with increased rates of non-guideline-based treatment for women and Black and Hispanic patients. These findings suggest that further research into the mechanisms underlying these disparities is warranted and that clinical and policy decision-making should take these disparities into account.
摘要：
■已经发现在提供医疗保健方面存在显著的人口差异。与肾癌临床决策相关的人口统计学因素尚未得到彻底研究。
■要确定人口统计学因素是否，包括性别和种族/民族，与接受基于非指南的肾癌治疗相关。
■这项回顾性队列研究是使用国家癌症数据库2010年至2017年的数据进行的。纳入的患者是年龄在30至70岁之间的局限性患者(即，cT1-2，N0，M0）肾癌且无主要医疗合并症（即，Charlson-Deyo合并症指数得分为0或1）在美国癌症委员会认可的医疗机构接受治疗。数据从2020年11月到2021年3月进行了分析。
■人口因素，包括性,种族/民族,和保险状况。
■接受肾癌的非指南治疗（治疗不足或过度治疗），根据公认的临床指南的定义，已确定。
■在158445名接受局部肾癌治疗的患者中，99563（62.8％）是男性，120001人（75.7%）是白人，91218人(57.6%)有私人保险。中位（四分位距）年龄为58（50-64）岁。在研究人群中，48544人（30.6%）接受非指南治疗。女性性别与治疗不足的调整几率较低相关(优势比[OR]，0.82；95%CI，0.77-0.88；P<.001）和较高的调整后过度治疗几率（OR，1.27；95%CI，1.24-1.30；P<.001）与男性相比。与白人患者相比，黑人和西班牙裔患者治疗不足的调整几率较高(黑人患者：OR，1.42；95%CI，1.29-1.55；P<.001；西班牙裔患者：OR，1.20；95%CI，1.06-1.36；P=0.004）和过度治疗（黑人患者：OR，1.09；95%CI，1.05-1.13；P<.001；西班牙裔患者：OR，1.06；95%CI，1.01-1.11，P=0.01）。没有保险的人，与那些有保险的人相比，在统计学上显著高于调整后的治疗不足几率(OR，2.63；95%CI，2.29-3.01；P<.001）和较低的调整后过度治疗几率（OR，0.72；95%CI，0.67-0.77；P<.001）。
■这项研究发现，肾癌患者在治疗决策方面存在显著差异，女性、黑人和西班牙裔患者接受非指南治疗的比率增加。这些发现表明，有必要对这些差异的潜在机制进行进一步研究，并且临床和政策决策应考虑这些差异。
■要确定人口统计学因素是否，包括性别和种族/民族，与接受基于非指南的肾癌治疗相关。
■这项回顾性队列研究是使用国家癌症数据库2010年至2017年的数据进行的。纳入的患者是年龄在30至70岁之间的局限性患者(即，cT1-2，N0，M0）肾癌且无主要医疗合并症（即，Charlson-Deyo合并症指数得分为0或1）在美国癌症委员会认可的医疗机构接受治疗。数据从2020年11月到2021年3月进行了分析。
■人口因素，包括性,种族/民族,和保险状况。
■接受肾癌的非指南治疗（治疗不足或过度治疗），根据公认的临床指南的定义，已确定。
■在158445名接受局部肾癌治疗的患者中，99563（62.8％）是男性，120001人（75.7%）是白人，91218人(57.6%)有私人保险。中位（四分位距）年龄为58（50-64）岁。在研究人群中，48544人（30.6%）接受非指南治疗。女性性别与治疗不足的调整几率较低相关(优势比[OR]，0.82；95%CI，0.77-0.88；P<.001）和较高的调整后过度治疗几率（OR，1.27；95%CI，1.24-1.30；P<.001）与男性相比。与白人患者相比，黑人和西班牙裔患者治疗不足的调整几率较高(黑人患者：OR，1.42；95%CI，1.29-1.55；P<.001；西班牙裔患者：OR，1.20；95%CI，1.06-1.36；P=0.004）和过度治疗（黑人患者：OR，1.09；95%CI，1.05-1.13；P<.001；西班牙裔患者：OR，1.06；95%CI，1.01-1.11，P=0.01）。没有保险的人，与那些有保险的人相比，在统计学上显著高于调整后的治疗不足几率(OR，2.63；95%CI，2.29-3.01；P<.001）和较低的调整后过度治疗几率（OR，0.72；95%CI，0.67-0.77；P<.001）。
■这项研究发现，肾癌患者在治疗决策方面存在显著差异，女性、黑人和西班牙裔患者接受非指南治疗的比率增加。这些发现表明，有必要对这些差异的潜在机制进行进一步研究，并且临床和政策决策应考虑这些差异。
