PDF(Pubmed)
Abstract：
Importance: The reasons underlying racial/ethnic mortality disparities for cancer patients remain poorly understood, especially regarding the role of access to care. Participants: Over five million patients with a primary diagnosis of lung, breast, prostate, colon/rectum, pancreas, ovary, or liver cancer during 2004-2014, were identified from the National Cancer Database. Cox proportional hazards models were applied to estimate hazard ratios (HR) and 95% confidence intervals (CI) for total mortality associated with race/ethnicity, and access to care related factors (i.e., socioeconomic status [SES], insurance, treating facility, and residential type) for each cancer. Results: Racial/ethnic disparities in total mortality were observed across seven cancers. Compared with non-Hispanic (NH)-white patients, NH-black patients with breast (HR = 1.27, 95% CI: 1.26 to 1.29), ovarian (HR = 1.20, 95% CI: 1.17 to 1.23), prostate (HR = 1.31, 95% CI: 1.30 to 1.33), colorectal (HR = 1.11, 95% CI: 1.10 to 1.12) or pancreatic (HR = 1.03, 95% CI: 1.02 to 1.05) cancers had significantly elevated mortality, while Asians (13-31%) and Hispanics (13-19%) had lower mortality for all cancers. Racial/ethnic disparities were observed across all strata of access to care related factors and modified by those factors. NH-black and NH-white disparities were most evident among patients with high SES or those with private insurance, while Hispanic/Asian versus NH-white disparities were more evident among patients with low SES or those with no/poor insurance. Conclusions and Relevance: Racial/ethnic mortality disparities for major cancers exist across all patient groups with different access to care levels. The influence of SES or insurance on mortality disparity follows different patterns for racial/ethnic minorities versus NH-whites. Impact: Our study highlights the need for racial/ethnic-specific strategies to reduce the mortality disparities for major cancers.
摘要：
重要性：癌症患者种族/族裔死亡率差异的潜在原因仍然知之甚少，特别是关于获得护理的作用。参与者：超过500万患者的主要诊断为肺，乳房,前列腺,结肠/直肠,胰腺,子房,或肝癌在2004-2014年，从国家癌症数据库中确定。Cox比例风险模型用于估计与种族/民族相关的总死亡率的风险比（HR）和95％置信区间（CI）。和获得护理相关因素(即，社会经济地位[SES]，保险,治疗设施，和居住类型)为每个癌症。结果：在7种癌症中观察到了总死亡率的种族/族裔差异。与非西班牙裔（NH）白人患者相比，NH-black乳腺患者（HR=1.27，95％CI：1.26至1.29），卵巢（HR=1.20，95%CI：1.17至1.23），前列腺（HR=1.31，95%CI：1.30至1.33），结直肠癌（HR=1.11，95%CI：1.10至1.12）或胰腺癌（HR=1.03，95%CI：1.02至1.05）死亡率显著升高，而亚洲人（13-31％）和西班牙裔（13-19％）对所有癌症的死亡率较低。在获得护理相关因素的所有阶层中都观察到种族/种族差异，并受这些因素的影响。NH-black和NH-white差异在SES高或有私人保险的患者中最为明显，而西班牙裔/亚裔与NH-白种人的差异在SES较低或无/低保险的患者中更为明显。结论和相关性：主要癌症的种族/种族死亡率差异存在于获得不同护理水平的所有患者群体中。SES或保险对死亡率差异的影响遵循种族/族裔少数群体与NH白人的不同模式。影响：我们的研究强调需要针对种族/民族的策略来减少主要癌症的死亡率差异。
