METHODS: We conducted a retrospective cohort study of adults with acute leukemia (2010-2019) residing within Massachusetts, the designated catchment area of the Dana-Farber/Harvard Cancer Center (DF/HCC). Individuals were categorized as non-Hispanic Asian (NHA), Black (NHB), White (NHW), Hispanic White (HW), or Other. Decomposition analyses assessed covariate contributions to disparities in (1) access to DF/HCC care and (2) post-access enrollment.
RESULTS: Of 3698 individuals with acute leukemia, 85.9% were NHW, 4.5% HW, 4.3% NHB, 3.7% NHA, and 1.3% Other. Access was lower for HW (age- and sex-adjusted OR = 0.64, 95% CI = 0.45 to 0.90) and reduced post-access enrollment for HW (aOR = 0.54, 95% CI =0.34 to 0.86) and NHB (aOR = 0.60, 95% CI = 0.39 to 0.92) compared to NHW. Payor and socioeconomic status (SES) accounted for 25.2% and 21.2% of the +1.1% absolute difference in HW access. Marital status and SES accounted for 8.0% and 7.0% of the -8.8% absolute disparity in HW enrollment; 76.4% of the disparity was unexplained. SES and marital status accounted for 8.2% and 7.1% of the -9.1% absolute disparity in NHB enrollment; 73.0% of the disparity was unexplained.
CONCLUSIONS: A substantial proportion of racial and ethnic inequities in acute leukemia trial enrollment at CCCs are from post-access enrollment, the majority of which was not explained by sociodemographic factors.
方法:我们对居住在马萨诸塞州的急性白血病成人(2010-2019)进行了一项回顾性队列研究。Dana-Farber/哈佛癌症中心(DF/HCC)的指定集水区。个人被归类为非西班牙裔亚洲人(NHA),黑色(NHB),白色(NHW),西班牙裔白人(HW),或其他。分解分析评估了协变量对(1)获得DF/HCC护理和(2)获得后登记差异的贡献。
结果:在3698例急性白血病患者中,NHW占85.9%,4.5%硬件,4.3%NHB,3.7%NHA,和1.3%其他。与NHW相比,HW的访问率较低(年龄和性别调整OR0.6495CI0.45,0.90),并且HW(aOR0.5495CI0.34,0.86)和NHB(aOR0.6095CI0.39,0.92)的访问后入学人数减少。付款人和社会经济地位(SES)占HW访问的+1.1%绝对差异的25.2%和21.2%。婚姻状况和SES分别占HW入学-8.8%绝对差异的8.0%和7.0%;76.4%的差异无法解释。SES和婚姻状况分别占NHB入学-9.1%绝对差异的8.2%和7.1%;73.0%的差异无法解释。
结论:在CCCs的急性白血病试验中,相当大比例的种族/族裔不平等来自入学后的入学,其中大部分不能用社会人口因素来解释。