背景:生殖系基因检测是指南推荐的胰腺男性癌症治疗的重要组成部分,乳房,或者转移性前列腺癌.我们试图确定在该人群中完成种系基因检测是否存在种族差异。
方法:这项回顾性队列研究包括非西班牙裔白人和黑人男性,乳房,或2019年1月1日至2021年9月30日之间的转移性前列腺癌。检查了两个全国性的队列:(1)行政索赔数据库中的商业保险个人,和(2)在退伍军人健康管理局接受护理的退伍军人。使用Kaplan-Meier方法估计一年的种系基因检测率。Cox比例风险回归用于测试种族与基因测试完成之间的关联。进行了因果调解分析,以调查社会经济变量是否有助于种族和种系测试之间的关联。
结果:我们的队列包括7,894名男性(5,142名商业保险;2,752名退伍军人)。商业保险个人的一年检测率为18.0%(95%CI,16.8%-19.2%),退伍军人为14.2%(95%CI,11.5%-15.0%)。黑人种族与商业保险个体中测试的风险较低相关(调整后的风险比[aHR],0.73;95%CI,0.58-0.91;P=0.005),但退伍军人(AHR,0.99;95%CI,0.75-1.32;P=.960)。在商业保险的个人中,收入(AHR,0.90;95%CI,0.86-0.96)和净资产(AHR,0.92;95%CI,0.86-0.98)介导的种族差异,而教育(AHR,0.98;95%CI,0.94-1.01)没有。
结论:在男性胰腺患者中,指南推荐的基因检测总体比率较低,乳房,或者转移性前列腺癌.在商业保险人群中,男性在基因检测中存在种族差异,以净资产和家庭收入为中介;这些差距在平等获得退伍军人健康管理局中没有看到。减轻金融和获取障碍可能会减轻基因检测中的种族差异。
Germline genetic testing is a vital component of guideline-recommended cancer care for males with pancreatic, breast, or metastatic prostate cancers. We sought to determine whether there were racial disparities in germline genetic testing completion in this population.
This retrospective cohort study included non-Hispanic White and Black males with incident pancreatic, breast, or metastatic prostate cancers between January 1, 2019, and September 30, 2021. Two nationwide cohorts were examined: (1) commercially insured individuals in an administrative claims database, and (2) Veterans receiving care in the Veterans Health Administration. One-year germline genetic testing rates were estimated by using Kaplan-Meier methods. Cox proportional hazards regression was used to test the association between race and genetic testing completion. Causal mediation analyses were performed to investigate whether socioeconomic variables contributed to associations between race and germline testing.
Our cohort consisted of 7,894 males (5,142 commercially insured; 2,752 Veterans). One-year testing rates were 18.0% (95% CI, 16.8%-19.2%) in commercially insured individuals and 14.2% (95% CI, 11.5%-15.0%) in Veterans. Black race was associated with a lower hazard of testing among commercially insured individuals (adjusted hazard ratio [aHR], 0.73; 95% CI, 0.58-0.91; P=.005) but not among Veterans (aHR, 0.99; 95% CI, 0.75-1.32; P=.960). In commercially insured individuals, income (aHR, 0.90; 95% CI, 0.86-0.96) and net worth (aHR, 0.92; 95% CI, 0.86-0.98) mediated racial disparities, whereas education (aHR, 0.98; 95% CI, 0.94-1.01) did not.
Overall rates of guideline-recommended genetic testing are low in males with pancreatic, breast, or metastatic prostate cancers. Racial disparities in genetic testing among males exist in a commercially insured population, mediated by net worth and household income; these disparities are not seen in the equal-access Veterans Health Administration. Alleviating financial and access barriers may mitigate racial disparities in genetic testing.