PDF(Pubmed)
Abstract：
UNASSIGNED: Non-Hispanic Black (NHB) Americans have a higher incidence of colorectal cancer (CRC) and worse survival than non-Hispanic white (NHW) Americans, but the relative contributions of biological versus access to care remain poorly characterized. This study used two nationwide cohorts in different healthcare contexts to study health system effects on this disparity.
UNASSIGNED: We used data from the Surveillance, Epidemiology, and End Results (SEER) registry as well as the United States Veterans Health Administration (VA) to identify adults diagnosed with colorectal cancer between 2010 and 2020 who identified as non-Hispanic Black (NHB) or non-Hispanic white (NHW). Stratified survival analyses were performed using a primary endpoint of overall survival, and sensitivity analyses were performed using cancer-specific survival.
UNASSIGNED: We identified 263,893 CRC patients in the SEER registry (36,662 (14%) NHB; 226,271 (86%) NHW) and 24,375 VA patients (4,860 (20%) NHB; 19,515 (80%) NHW). In the SEER registry, NHB patients had worse OS than NHW patients: median OS of 57 months (95% confidence interval (CI) 55-58) versus 72 months (95% CI 71-73) (hazard ratio (HR) 1.14, 95% CI 1.12-1.15, p = 0.001). In contrast, VA NHB median OS was 65 months (95% CI 62-69) versus NHW 69 months (95% CI 97-71) (HR 1.02, 95% CI 0.98-1.07, p = 0.375). There was significant interaction in the SEER registry between race and Medicare age eligibility (p < 0.001); NHB race had more effect in patients <65 years old (HR 1.44, 95% CI 1.39-1.49, p < 0.001) than in those ≥65 (HR 1.13, 95% CI 1.11-1.15, p < 0.001). In the VA, age stratification was not significant (p = 0.21).
UNASSIGNED: Racial disparities in CRC survival in the general US population are significantly attenuated in Medicare-aged patients. This pattern is not present in the VA, suggesting that access to care may be an important component of racial disparities in this disease.
UNASSIGNED: We used data from the Surveillance, Epidemiology, and End Results (SEER) registry as well as the United States Veterans Health Administration (VA) to identify adults diagnosed with colorectal cancer between 2010 and 2020 who identified as non-Hispanic Black (NHB) or non-Hispanic white (NHW). Stratified survival analyses were performed using a primary endpoint of overall survival, and sensitivity analyses were performed using cancer-specific survival.
UNASSIGNED: We identified 263,893 CRC patients in the SEER registry (36,662 (14%) NHB; 226,271 (86%) NHW) and 24,375 VA patients (4,860 (20%) NHB; 19,515 (80%) NHW). In the SEER registry, NHB patients had worse OS than NHW patients: median OS of 57 months (95% confidence interval (CI) 55-58) versus 72 months (95% CI 71-73) (hazard ratio (HR) 1.14, 95% CI 1.12-1.15, p = 0.001). In contrast, VA NHB median OS was 65 months (95% CI 62-69) versus NHW 69 months (95% CI 97-71) (HR 1.02, 95% CI 0.98-1.07, p = 0.375). There was significant interaction in the SEER registry between race and Medicare age eligibility (p < 0.001); NHB race had more effect in patients <65 years old (HR 1.44, 95% CI 1.39-1.49, p < 0.001) than in those ≥65 (HR 1.13, 95% CI 1.11-1.15, p < 0.001). In the VA, age stratification was not significant (p = 0.21).
UNASSIGNED: Racial disparities in CRC survival in the general US population are significantly attenuated in Medicare-aged patients. This pattern is not present in the VA, suggesting that access to care may be an important component of racial disparities in this disease.
摘要：
■非西班牙裔黑人（NHB）美国人与非西班牙裔白人（NHW）美国人相比，结直肠癌（CRC）的发病率更高，生存率更差。但是生物学相对于获得护理的相对贡献仍然缺乏表征。这项研究使用了两个在不同医疗保健环境中的全国性队列来研究卫生系统对这种差异的影响。
■我们使用了监测数据，流行病学,和最终结果（SEER）注册表以及美国退伍军人健康管理局（VA），以确定2010年至2020年之间被诊断为非西班牙裔黑人（NHB）或非西班牙裔白人（NHW）的成年人。使用总生存期的主要终点进行分层生存分析，使用癌症特异性生存率进行敏感性分析.
■我们在SEER注册中确定了263,893例CRC患者（36,662（14％）NHB；226,271（86％）NHW）和24,375例VA患者（4,860（20％）NHB；19,515（80％）NHW）。在SEER注册表中，NHB患者的OS比NHW患者差：中位OS为57个月（95％置信区间（CI）55-58）与72个月（95％CI71-73）（风险比（HR）1.14，95％CI1.12-1.15，p=0.001）。相比之下,VANHB中位OS为65个月（95％CI62-69），NHW为69个月（95％CI97-71）（HR1.02，95％CI0.98-1.07，p=0.375）。在SEER注册中，种族和Medicare年龄资格之间存在显着相互作用（p<0.001）；NHB种族对<65岁的患者（HR1.44，95％CI1.39-1.49，p<0.001）的影响大于≥65岁的患者（HR1.13，95％CI1.11-1.15，p<0.001）。在VA中,年龄分层不显著(p=0.21).
■在美国普通人群中，CRC生存率的种族差异在医疗保险老年患者中显著减弱。这种模式在VA中不存在，这表明获得护理可能是这种疾病种族差异的重要组成部分。
■我们使用了监测数据，流行病学,和最终结果（SEER）注册表以及美国退伍军人健康管理局（VA），以确定2010年至2020年之间被诊断为非西班牙裔黑人（NHB）或非西班牙裔白人（NHW）的成年人。使用总生存期的主要终点进行分层生存分析，使用癌症特异性生存率进行敏感性分析.
■我们在SEER注册中确定了263,893例CRC患者（36,662（14％）NHB；226,271（86％）NHW）和24,375例VA患者（4,860（20％）NHB；19,515（80％）NHW）。在SEER注册表中，NHB患者的OS比NHW患者差：中位OS为57个月（95％置信区间（CI）55-58）与72个月（95％CI71-73）（风险比（HR）1.14，95％CI1.12-1.15，p=0.001）。相比之下,VANHB中位OS为65个月（95％CI62-69），NHW为69个月（95％CI97-71）（HR1.02，95％CI0.98-1.07，p=0.375）。在SEER注册中，种族和Medicare年龄资格之间存在显着相互作用（p<0.001）；NHB种族对<65岁的患者（HR1.44，95％CI1.39-1.49，p<0.001）的影响大于≥65岁的患者（HR1.13，95％CI1.11-1.15，p<0.001）。在VA中,年龄分层不显著(p=0.21).
■在美国普通人群中，CRC生存率的种族差异在医疗保险老年患者中显著减弱。这种模式在VA中不存在，这表明获得护理可能是这种疾病种族差异的重要组成部分。
