在接受卵巢癌(OC)的指南一致治疗时存在种族差异。然而,很少有研究评估医疗保健服务(HCA)的各个维度是如何导致这些差异的。
我们分析了来自非西班牙裔(NH)-布莱克的数据,西班牙裔,从SEER-Medicare数据库中诊断出2008年至2015年患有OC的NH-White患者,并将HCA维度定义为可负担性,可用性,和可访问性,用因子分析创建的总分衡量。根据卵巢癌NCCN指南定义了指南一致的OC手术和化疗。使用多变量调整的改良Poisson回归模型来评估与HCA相关的指南一致治疗的相对风险(RR)。
研究队列包括5,632名患者:6%NH-Black,6%的西班牙裔,88%的NH-White。只有23.8%的NH-White患者接受了指南一致的手术和完整的化疗周期,而NH-Black患者为14.2%。更高的负担能力(RR,1.05;95%CI,1.01-1.08)和可用性(RR,1.06;95%CI,1.02-1.10)与接受指南一致的手术有关,而较高的负担能力与开始全身治疗相关(风险比,1.09;95%CI,1.05-1.13)。在调整了所有3个HCA评分以及人口统计学和临床特征后,NH-Black患者比NH-White患者开始全身治疗的可能性较小(风险比,0.86;95%CI,0.75-0.99)。
多个HCA维度可预测是否接受与指南一致的治疗,但不能完全解释OC患者的种族差异。可接受性和适应性是两个额外的HCA维度,这对于解决这些差异可能至关重要。
Racial disparities exist in receipt of
guideline-concordant treatment of ovarian cancer (OC). However, few studies have evaluated how various dimensions of healthcare access (HCA) contribute to these disparities.
We analyzed data from non-Hispanic (NH)-Black, Hispanic, and NH-White patients with OC diagnosed in 2008 to 2015 from the SEER-Medicare database and defined HCA dimensions as affordability, availability, and accessibility, measured as aggregate scores created with factor analysis. Receipt of
guideline-concordant OC surgery and chemotherapy was defined based on the NCCN
Guidelines for Ovarian Cancer. Multivariable-adjusted modified Poisson regression models were used to assess the relative risk (RR) for guideline-concordant treatment in relation to HCA.
The study cohort included 5,632 patients: 6% NH-Black, 6% Hispanic, and 88% NH-White. Only 23.8% of NH-White patients received
guideline-concordant surgery and the full cycles of chemotherapy versus 14.2% of NH-Black patients. Higher affordability (RR, 1.05; 95% CI, 1.01-1.08) and availability (RR, 1.06; 95% CI, 1.02-1.10) were associated with receipt of
guideline-concordant surgery, whereas higher affordability was associated with initiation of systemic therapy (hazard ratio, 1.09; 95% CI, 1.05-1.13). After adjusting for all 3 HCA scores and demographic and clinical characteristics, NH-Black patients remained less likely than NH-White patients to initiate systemic therapy (hazard ratio, 0.86; 95% CI, 0.75-0.99).
Multiple HCA dimensions predict receipt of
guideline-concordant treatment but do not fully explain racial disparities among patients with OC. Acceptability and accommodation are 2 additional HCA dimensions which may be critical to addressing these disparities.