Haggstrom David A, Quale Chris, Smith-Bindman Rebecca
Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-7344, USA.
Cancer. 2005 Dec 1;104(11):2347-58. doi: 10.1002/cncr.21443.
It is unknown whether differences in the quality of breast cancer care among women from racial and ethnic minority groups, the elderly, and rural areas have changed over time across the continuum of care.
The linked Surveillance, Epidemiology, and End Results-Medicare database identified 22,701 women ages 66-79 years diagnosed with early stage breast cancer from 1992-1999. Multiple breast cancer processes of care were measured, including breast-conserving surgery, radiation therapy, documentation of estrogen receptor status, surveillance mammography, and a combined measure of "adequate care".
African-American and Hispanic women were significantly less likely to receive adequate care than White women in unadjusted comparisons (54.7% and 58.0% vs. 68.4% for African-American and Hispanic vs. White women) and adjusted comparisons (adjusted odds ratio [AOR] 0.67; 95% confidence interval [95% CI] 0.59-0.76, and AOR 0.77; 95% CI 0.66-0.90 for African-American and Hispanic women, respectively). The proportion of Asian/Pacific Islander women receiving adequate care was similar to White women. When considering only women diagnosed with breast cancer from 1997-1999, African-American women remained less likely than White women to receive adequate care (AOR 0.63; 95% CI 0.50-0.79). Women ages 75-79 years were less likely to receive adequate care compared with women ages 66-69 years (AOR 0.74; 95% CI 0.69-0.80), and women from rural (vs. metropolitan) areas were less likely to receive adequate care (AOR 0.81; 95% CI 0.73-0.89).
The quality of breast cancer care is lower among vulnerable populations across the continuum of care, and many of these differences have not improved in more recent years.
尚不清楚种族和少数民族女性、老年女性以及农村地区女性在乳腺癌护理质量上的差异在整个护理过程中是否随时间发生了变化。
通过关联的监测、流行病学和最终结果-医疗保险数据库，确定了1992年至1999年间22701名年龄在66至79岁之间被诊断为早期乳腺癌的女性。对多种乳腺癌护理过程进行了测量，包括保乳手术、放射治疗、雌激素受体状态记录、监测性乳房X光检查以及“充分护理”的综合指标。
在未经调整的比较中，非裔美国女性和西班牙裔女性接受充分护理的可能性显著低于白人女性（非裔美国女性和西班牙裔女性分别为54.7%和58.0%，白人女性为68.4%），在调整后的比较中也是如此（调整后的优势比[AOR]分别为0.67；95%置信区间[95%CI]为0.59 - 0.76，以及AOR为0.77；95%CI为0.66 - 0.90）。亚裔/太平洋岛民女性接受充分护理的比例与白人女性相似。仅考虑1997年至1999年被诊断为乳腺癌的女性时，非裔美国女性接受充分护理的可能性仍低于白人女性（AOR为0.63；95%CI为0.50 - 0.79）。75至79岁的女性与66至69岁的女性相比，接受充分护理的可能性较小（AOR为0.74；95%CI为0.69 - 0.80），农村（与大都市地区相比）女性接受充分护理的可能性较小（AOR为0.81；95%CI为0.73 - 0.89）。
在整个护理过程中，弱势群体的乳腺癌护理质量较低，而且近年来其中许多差异并未得到改善。
