Rose Adam J, Backus Bertina M, Gershman Susan T, Santos Palmira, Ash Arlene S, Battaglia Tracy A
Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts 02118-2644, USA.
Med Care. 2007 May;45(5):440-7. doi: 10.1097/01.mlr.0000257144.29928.f0.
Most studies have found that black men are less likely to receive aggressive therapy for nonmetastatic prostate cancer, even after controlling for covariates. However, previous studies have not accounted for the clustering of outcomes by facility.
We sought to compare the proportions of black and white men receiving aggressive therapy for newly diagnosed nonmetastatic prostate cancer between 1998 and 2002, accounting for the clustering of outcomes by facility.
We used the Massachusetts Cancer Registry of all cancer diagnosed in residents of Massachusetts. We used logistic regression, clustering by the facility where the tumor was diagnosed, to predict the probability that a patient would receive any aggressive therapy, and the specific therapeutic choices of radical prostatectomy, external-beam radiation therapy, and brachytherapy. Predictors included race, age, poverty, insurance status, marital status, year of diagnosis, and tumor grade.
Black men were similarly likely to receive aggressive therapy compared with white men (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.62-1.01). However, there was a racial difference in the receipt of particular types of therapy: black men were significantly more likely to receive radiation therapy (OR 1.39, 95% CI 1.16-1.68) and less likely to receive radical prostatectomy (OR 0.53, 95% CI 0.38-0.74).
Among men diagnosed with nonmetastatic prostate cancer in Massachusetts from 1998 to 2002, black men received aggressive therapy at rates approaching those of whites. However, they were more likely to receive radiation therapy and less likely to receive radical prostatectomy.
大多数研究发现，即便在控制协变量之后，黑人男性接受非转移性前列腺癌积极治疗的可能性仍较低。然而，既往研究未考虑到治疗结果在医疗机构层面的聚集性。
我们试图比较1998年至2002年间新诊断为非转移性前列腺癌的黑人和白人男性接受积极治疗的比例，并考虑治疗结果在医疗机构层面的聚集性。
我们使用了马萨诸塞州居民所有癌症诊断信息的马萨诸塞州癌症登记处数据。我们采用逻辑回归分析，以肿瘤诊断所在的医疗机构为聚类单位，预测患者接受任何积极治疗的概率，以及前列腺癌根治术、外照射放疗和近距离放疗等具体治疗选择的概率。预测因素包括种族、年龄、贫困状况、保险状况、婚姻状况、诊断年份和肿瘤分级。
与白人男性相比，黑人男性接受积极治疗的可能性相似（优势比[OR]为0.79，95%置信区间[CI]为0.62 - 1.01）。然而，在接受特定类型治疗方面存在种族差异：黑人男性接受放疗的可能性显著更高（OR为1.39，95%CI为1.16 - 1.68），而接受前列腺癌根治术的可能性更低（OR为0.53，95%CI为0.38 - 0.74）。
在1998年至2002年期间在马萨诸塞州被诊断为非转移性前列腺癌的男性中，黑人男性接受积极治疗的比例接近白人。然而，他们接受放疗的可能性更高，接受前列腺癌根治术的可能性更低。
