■非洲裔美国患者经常接受非标准治疗,并且与白人患者相比,其总体生存(OS)结果较差。我们的目的是分析在考虑临床特征后,直肠癌特异性死亡率的种族/族裔差异是否仍然存在,治疗,以及获得护理的相关因素。
■使用监测对2011年至2020年之间诊断为直肠癌的个体进行了鉴定,流行病学,和最终结果数据库。计算直肠癌特异性死亡率的累积发生率。使用精细和灰色模型并逐步调整临床特征,估计与种族/民族相关的直肠癌特异性死亡率的子分布风险比(sdHR)和95%置信区间(CI)。治疗方式,以及与获得护理相关的因素。
■在54,370名患者中,非西班牙裔(NH)黑人个体表现出最高的直肠癌特异性死亡率(39%),其次是美洲印第安人/阿拉斯加原住民(AI/AN)(35%),西班牙裔(32%),NH-White(31%),和亚洲/太平洋岛民(API)(30%)。在调整临床特征后,NH-Black患者的直肠癌死亡率风险增加了28%(sdHR,1.28;95%CI:1.20-1.35)与NH-White患者相比。相比之下,西班牙裔白人之间的死亡率差异,AI/AN-White,和API-White组无显著性差异。即使在调整治疗和获得护理相关因素后,黑白死亡率差异仍然存在。在分层分析中,在家庭收入中位数低于$59,999的患者中,经临床特征校正后,AI/AN患者的死亡率高于NH-Whites(sdHR,1.32;95%CI:1.03-1.70)。
■总的来说,直肠癌特异性死亡率的种族/民族差异主要归因于临床特征的差异,治疗方式,以及与获得护理相关的因素。这些发现强调了对公平医疗保健的迫切需要,以有效解决和减少直肠癌预后中的重大种族/族裔差异。
UNASSIGNED: African American patients frequently receive nonstandard treatment and demonstrate poorer overall survival (OS) outcomes compared to White patients. Our objective was to analysis whether racial/ethnic disparities in rectal cancer-specific mortality remain after accounting for clinical characteristics, treatment, and access-to-care-related factors.
UNASSIGNED: Individuals diagnosed with rectal cancer between 2011 and 2020 were identified using the Surveillance, Epidemiology, and End Results Database. The cumulative incidence of rectal cancer-specific mortality was computed. Sub-distribution hazard ratios (sdHRs) and 95% confidence intervals (CIs) for rectal cancer-specific mortality associated with race/ethnicity were estimated using Fine and Gray model with stepwise adjustments for clinical characteristics, treatment modalities, and factors related to access-to-care.
UNASSIGNED: Among 54,370 patients, non-Hispanic (NH) Black individuals exhibited the highest cumulative incidence of rectal cancer-specific mortality (39%), followed by American Indian/Alaska Native (AI/AN) (35%), Hispanics (32%), NH-White (31%), and Asian/Pacific Islander (API) (30%). After adjusting for clinical characteristics, NH-Black patients had a 28% increased risk of rectal cancer mortality (sdHR, 1.28; 95% CI: 1.20-1.35) compared to NH-White patients. In contrast, mortality disparities between Hispanic-White, AI/AN-White, and API-White groups were not significant. The Black-White mortality differences persisted even after adjustments for treatment and access-to-care-related factors. In stratified analyses, among patients with a median household income below $59,999, AI/AN patients showed higher mortality than NH-Whites when adjusted for clinical characteristics (sdHR, 1.32; 95% CI: 1.03-1.70).
UNASSIGNED: Overall, the racial/ethnic disparities in rectal cancer-specific mortality were largely attributable to differences in clinical characteristics, treatment modalities, and factors related to access-to-care. These findings emphasize the critical need for equitable healthcare to effectively address and reduce the significant racial/ethnic disparities in rectal cancer outcomes.