背景:在美国(美国),尚不清楚哪些因素显著导致癌症生存率的种族差异。我们比较了美国人口水平和单一付款人医疗保健系统中来自不同种族和族裔的癌症患者的调整后死亡率结果。
方法:我们从监测中选择了患有实性和血液系统恶性肿瘤的成年患者,流行病学,和最终结果(SEER)2011-2020年和退伍军人事务国家医疗系统(VA)2011-2021年。我们将自我报告的NIH种族和种族分为非西班牙裔白人(NHW),非西班牙裔黑人(NHB),非西班牙裔亚洲太平洋岛民(API),和西班牙裔。在调整每个队列中的混杂因素后,建立了种族和族裔风险比的Cox回归模型。
结果:该研究包括来自SEER的3,104,657例患者和来自VA的287,619例患者。两组的基线特征存在显著差异。在SEER,死亡率的校正HR为1.12(95%CI,1.12-1.13),1.03(95%CI,1.03-1.04),和0.91(95%CI,0.90-0.92),对于NHB,西班牙裔,和API患者,分别,vs.NHW.在VA,调整后的HR为0.94(95%CI,0.92-0.95),0.84(95%CI,0.82-0.87),NHB为0.96(95%CI,0.93-1.00),西班牙裔,和API,分别,vs.NHW.按癌症类型进行的其他亚组分析,年龄,和性别没有显著改变这些关联.
结论:种族差异在美国人口水平上继续存在,尤其是NHB与NHW患者,在普通人群中,调整后的死亡率高出12%,但在单一支付者VA系统中,调整后的死亡率低6%.
BACKGROUND: It remains unclear what factors significantly drive racial disparity in cancer survival in the United States (US). We compared adjusted mortality outcomes in cancer patients from different racial and ethnic groups on a population level in the US and a single-payer healthcare system.
METHODS: We selected adult patients with incident solid and hematologic malignancies from the Surveillance, Epidemiology, and End Results (SEER) 2011-2020 and Veteran Affairs national healthcare system (VA) 2011-2021. We classified the self-reported NIH race and ethnicity into non-Hispanic White (NHW), non-Hispanic Black (NHB), non-Hispanic Asian Pacific Islander (API), and Hispanic. Cox regression models for hazard ratio of racial and ethnic groups were built after adjusting confounders in each cohort.
RESULTS: The study included 3,104,657 patients from SEER and 287,619 patients from VA. There were notable differences in baseline characteristics in the two cohorts. In SEER, adjusted HR for mortality was 1.12 (95% CI, 1.12-1.13), 1.03 (95% CI, 1.03-1.04), and 0.91 (95% CI, 0.90-0.92), for NHB, Hispanic, and API patients, respectively, vs. NHW. In VA, adjusted HR was 0.94 (95% CI, 0.92-0.95), 0.84 (95% CI, 0.82-0.87), and 0.96 (95% CI, 0.93-1.00) for NHB, Hispanic, and API, respectively, vs. NHW. Additional subgroup analyses by cancer types, age, and sex did not significantly change these associations.
CONCLUSIONS: Racial disparity continues to persist on a population level in the US especially for NHB vs. NHW patients, where the adjusted mortality was 12% higher in the general population but 6% lower in the single-payer VA system.