PDF(Pubmed)
Abstract：
BACKGROUND: Clinical trial participation at Comprehensive Cancer Centers (CCC) is inequitable for minoritized racial and ethnic groups with acute leukemia. CCCs care for a high proportion of adults with acute leukemia. It is unclear if participation inequities are due to CCC access, post-access enrollment, or both.
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.
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.
摘要：
背景：综合癌症中心（CCC）的临床试验参与对于患有急性白血病的少数种族/族裔群体是不公平的。CCCs治疗成人急性白血病的比例很高。目前还不清楚参与不平等是否是由于CCC访问，访问后注册，或者两者兼而有之。
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。
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。
