许多患有共病糖尿病的癌症幸存者比他们的非癌症同行接受更少的糖尿病管理。我们试图确定在乳腺癌事件发生后12个月内推荐的糖尿病治疗中是否存在种族/族裔差异,前列腺,或结直肠癌诊断。因为共病糖尿病会降低长期生存率,确定指南一致的糖尿病治疗的预测因素非常重要.
使用监视,流行病学,和与医疗保险索赔相关的癌症登记结果,我们包括67岁以上患有糖尿病和事件的受益人,非转移性乳腺,前列腺,或结直肠癌在2008年至2013年之间。主要结果是诊断后12个月的糖尿病护理服务:(1)HbA1c测试,(2)眼科检查,和(3)低密度脂蛋白(LDL)测试。使用具有鲁棒标准误差的修正泊松模型,我们分别检查了每个结果。
我们包括34,643名患有糖尿病和癌症的Medicare受益人。诊断时的平均年龄为76.1(SD6.2),47.2%是女性;35%有乳房,24%结直肠,和41%的前列腺癌.在癌症确诊后的12个月里,82.4%接受了HbA1c测试,55.3%的人接受了眼科检查,77.8%有低密度脂蛋白测试,42.0%接受了所有三项测试。与非西班牙裔白人相比,3%的黑人(95%CI0.95-0.98)不太可能接受HbA1c测试,10%(95%CI0.89-0.92)不太可能接受LDL测试,8%(95%0.89-0.95)不太可能接受检查眼睛。黑人和西班牙裔人接受所有三项检查的可能性分别为16%(95%CI0.81-0.88)和7%(0.88-0.98),在考虑了混杂因素后。种族/种族差异在癌症类型中持续存在。
有乳房的黑人和西班牙裔,前列腺,与非西班牙裔白人相比,结直肠癌和糖尿病在癌症诊断后接受的糖尿病护理较少。差异不能用社会经济因素或临床需要来解释。
我们的研究结果是关于种族/族裔少数群体中糖尿病的高患病率和不良癌症预后。调查的下一步是确定为什么少数民族不太可能接受全面的糖尿病护理,以便制定有针对性的策略,以增加对这些弱势群体的适当糖尿病管理。
Many cancer survivors with co-morbid diabetes receive less diabetes management than their non-cancer counterparts. We sought to determine if racial/ethnic disparities exist in recommended diabetes care within 12 months of an incident breast, prostate, or colorectal cancer diagnosis. Because co-morbid diabetes decreases long-term survival, identifying predictors of guideline-concordant diabetes care is important.
Using the Surveillance, Epidemiology, and End Results cancer registry linked to Medicare claims, we included beneficiaries aged 67+ years with diabetes and incident, non-metastatic breast, prostate, or colorectal cancer between 2008 and 2013. Primary outcomes were diabetes care services 12 months after diagnosis: (1) HbA1c test, (2) eye exam, and (3) low-density lipoprotein (LDL) test. Using modified Poisson models with robust standard errors, we examined each outcome separately.
We included 34,643 Medicare beneficiaries with both diabetes and cancer. Mean age at diagnosis was 76.1 (SD 6.2), 47.2% were women; 35% had breast, 24% colorectal, and 41% prostate cancer. In the 12 months after incident cancer diagnosis, 82.4% received an HbA1c test, 55.3% received an eye exam, 77.8% had an LDL test, and 42.0% received all three tests. Compared to non-Hispanic Whites, Blacks were 3% (95% CI 0.95-0.98) less likely to receive a HbA1c test, 10% (95% CI 0.89-0.92) less likely to receive a LDL test, and 8% (95% 0.89-0.95) less likely to receive an exam eye. Blacks and Hispanics were 16% (95% CI 0.81-0.88) and 7% (0.88-0.98) less likely to receive all three tests, after accounting for confounders. Racial/ethnic differences persisted across cancer types.
Blacks and Hispanics with breast, prostate, and colorectal cancer and diabetes received less diabetes care after cancer diagnosis compared to non-Hispanic Whites. Differences were not explained by socio-economic factors or clinical need.
Our findings are concerning given the high prevalence of diabetes and poor cancer outcomes among racial/ethnic minorities. The next step in this line of inquiry is to determine why minorities are less likely to receive comprehensive diabetes care in order to develop targeted strategies to increase receipt of appropriate diabetes management for these vulnerable populations.