PDF(Pubmed)
Abstract：
Delayed surgery is associated with worse lung cancer outcomes. Social determinants can influence health disparities. This study aimed to examine the potential racial disparity and the effects from social determinants on receipt of timely surgery among lung cancer patients in Louisiana, a southern state in the U.S. White and black stage I-IIIA non-small cell lung cancer patients diagnosed in Louisiana between 2004 and 2016, receiving surgical lobectomy or a more extensive surgery, were selected. Diagnosis-to-surgery interval >6 weeks were considered as delayed surgery. Social determinants included marital status, insurance, census tract level poverty, and census tract level urbanicity. Multivariable logistic regression and generalized multiple mediation analysis were conducted. A total of 3,616 white (78.9%) and black (21.1%) patients were identified. The median time interval from diagnosis to surgery was 27 days in whites and 42 days in blacks (P < 0.0001). About 28.7% of white and 48.4% of black patients received delayed surgery (P < 0.0001). Black patients had almost two-fold odds of receiving delayed surgery than white patients (adjusted odds ratio: 1.91; 95% confidence interval: 1.59-2.30). Social determinants explained about 26% of the racial disparity in receiving delayed surgery. Having social support, private insurance, and living in census tracts with lower poverty level were associated with improved access to timely surgery. The census tract level poverty level a stronger effect on delayed surgery in black patients than in white patients. Tailored interventions to improve the timely treatment in NSCLC patients, especially black patients, are needed in the future.
摘要：
延迟手术与更差的肺癌预后相关。社会决定因素会影响健康差异。这项研究旨在检查潜在的种族差异以及社会决定因素对路易斯安那州肺癌患者及时接受手术的影响，美国南部一个州，2004年至2016年间在路易斯安那州诊断出的白色和黑色I-IIIA期非小细胞肺癌患者，接受了手术肺叶切除术或更广泛的手术，被选中。诊断至手术间隔>6周被认为是延迟手术。社会决定因素包括婚姻状况，保险,人口普查区贫困水平，和人口普查区水平的城市化。采用多变量logistic回归和广义多元中介分析。共有3616名白人(78.9%)和黑人(21.1%)患者被确认。从诊断到手术的中位时间间隔在白人为27天，在黑人为42天（P<0.0001）。约28.7%的白人和48.4%的黑人患者接收延迟手术(P<0.0001)。黑人患者接受延迟手术的几率几乎是白人患者的两倍（调整后的优势比：1.91；95％置信区间：1.59-2.30）。社会决定因素解释了接受延迟手术的种族差异的26％。有社会支持,私人保险,生活在贫困水平较低的人口普查区与获得及时手术的机会有关。人口普查道贫困水平对黑人患者的延迟手术的影响要强于白人患者。量身定制的干预措施，以提高非小细胞肺癌患者的及时治疗，尤其是黑人患者,是未来需要的。
