Stevens Wendy, Stevens Graham, Kolbe John, Cox Brian
Discipline of Oncology, University of Auckland, Auckland, New Zealand.
J Thorac Oncol. 2008 Mar;3(3):237-44. doi: 10.1097/JTO.0b013e3181653d08.
Major ethnic disparities in lung cancer survival exist in New Zealand, with Mäori having a higher case-fatality ratio than non-Mäori.
To assess whether secondary care management of lung cancer differed by ethnicity and could contribute to ethnic survival disparities.
An audit of secondary care management in Auckland and Northland of lung cancer patients diagnosed in 2004 permitted comparison of the management of lung cancer in different ethnic groups.
The 565 eligible cases comprised: European 378 (67%), Mäori 95 (17%), Pacific Peoples 56 (10%), Asian 23 (4%), and other or unknown ethnicity 13 (2%). In multivariate analysis (adjusting for tumor and patient factors including comorbidity), Mäori were 2.5 times more likely to have locally advanced disease than localized disease compared with Europeans (p < 0.01), and four times less likely to receive curative rather than palliative anticancer treatment compared with Europeans (p < 0.01). Mäori had longer transit times from diagnosis to treatment (p < 0.001). Mäori were more likely to decline treatment and miss appointments than Europeans, although this only partially explained management differences.
Multiple factors are potentially responsible for the higher case-fatality ratio in Mäori. Such factors include presentation with more advanced disease, lower rates of curative treatment for nonmetastatic disease, and longer transit times from diagnosis to treatment. In this retrospective study, socioeconomic deprivation, comorbidity levels, and failure to accept treatment did not fully explain ethnic differences in management. Further assessment of the underlying issues by prospective evaluation is warranted.
在新西兰，肺癌生存率存在显著的种族差异，毛利人的病死率高于非毛利人。
评估肺癌的二级护理管理是否因种族而异，以及是否会导致种族生存差异。
对2004年在奥克兰和北地被诊断为肺癌的患者进行二级护理管理审计，以比较不同种族肺癌患者的管理情况。
565例符合条件的病例包括：欧洲人378例（67%），毛利人95例（17%），太平洋岛民56例（10%），亚洲人23例（4%），其他或种族不明者13例（2%）。在多变量分析中（调整肿瘤和患者因素，包括合并症），与欧洲人相比，毛利人患局部晚期疾病的可能性是局限性疾病的2.5倍（p<0.01），接受根治性而非姑息性抗癌治疗的可能性比欧洲人低四倍（p<0.01）。毛利人从诊断到治疗的周转时间更长（p<0.001）。与欧洲人相比，毛利人更有可能拒绝治疗和错过预约，尽管这只是部分解释了管理差异。
多种因素可能导致毛利人较高的病死率。这些因素包括病情更严重、非转移性疾病的根治性治疗率较低以及从诊断到治疗的周转时间较长。在这项回顾性研究中，社会经济剥夺、合并症水平以及拒绝接受治疗并不能完全解释管理方面的种族差异。有必要通过前瞻性评估对潜在问题进行进一步评估。
