Carpenter William R, Godley Paul A, Clark Jack A, Talcott James A, Finnegan Timothy, Mishel Merle, Bensen Jeannette, Rayford Walter, Su L Joseph, Fontham Elizabeth T H, Mohler James L
Department of Health Policy and Management, University of North Carolina School of Public Health, Chapel Hill, North Carolina, USA.
Cancer. 2009 Nov 1;115(21):5048-59. doi: 10.1002/cncr.24539.
: Nonmedical factors may modify the biological risk of prostate cancer (PCa) and contribute to the differential use of early detection; curative care; and, ultimately, greater racial disparities in PCa mortality. In this study, the authors examined patients' usual source of care, continuity of care, and mistrust of physicians and their association with racial differences in PCa screening.
: Study nurses conducted in-home interviews of 1031 African-American men and Caucasian-American men aged > or =50 years in North Carolina and Louisiana within weeks of their PCa diagnosis. Medical records were abstracted, and the data were used to conduct bivariate and multivariate analyses.
: Compared with African Americans, Caucasian Americans exhibited higher physician trust scores and a greater likelihood of reporting a physician office as their usual source of care, seeing the same physician at regular medical encounters, and historically using any PCa screening. Seeing the same physician for regular care was associated with greater trust and screening use. Men who reported their usual source of care as a physician office, hospital clinic, or Veterans Administration facility were more likely to report prior PCa screening than other men. In multivariate regression analysis, seeing the same provider remained associated with prior screening use, whereas both race and trust lost their association with prior screening.
: The current results indicated that systems factors, including those that differ among different sources of care and those associated with the continuity of care, may provide tangible targets to address disparities in the use of PCa early detection, may attenuate racial differences in PCa screening use, and may contribute to reduced racial disparities in PCa mortality. Cancer 2009. Published 2009 by the American Cancer Society.
非医学因素可能改变前列腺癌（PCa）的生物学风险，并导致早期检测、治愈性治疗的使用差异，最终导致PCa死亡率方面更大的种族差异。在本研究中，作者调查了患者通常的医疗服务来源、医疗连续性以及对医生的不信任感，及其与PCa筛查中种族差异的关联。
研究护士在北卡罗来纳州和路易斯安那州对1031名年龄≥50岁的非裔美国男性和高加索裔美国男性在其PCa诊断后的几周内进行了家访。提取了医疗记录，并使用这些数据进行双变量和多变量分析。
与非裔美国人相比，高加索裔美国人表现出更高的医生信任评分，更有可能报告医生办公室是他们通常的医疗服务来源，在定期医疗就诊时看同一位医生，以及既往进行过任何PCa筛查。定期看同一位医生与更高的信任度和筛查使用率相关。报告其通常的医疗服务来源为医生办公室、医院诊所或退伍军人管理局设施的男性比其他男性更有可能报告既往进行过PCa筛查。在多变量回归分析中，看同一位医疗服务提供者仍然与既往筛查使用相关，而种族和信任度与既往筛查的关联消失。
目前的结果表明，系统因素，包括不同医疗服务来源之间存在差异的因素以及与医疗连续性相关的因素，可能为解决PCa早期检测使用方面的差异提供切实可行的目标，可能减少PCa筛查使用中的种族差异，并可能有助于减少PCa死亡率方面的种族差异。《癌症》2009年。2009年由美国癌症协会出版。
