Prevention Research Center, Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia 30310-1495, USA.
Cancer. 2010 Feb 1;116(3):713-22. doi: 10.1002/cncr.24757.
Several studies have attributed racial disparities in cancer incidence and mortality to variances in socioeconomic status and health insurance coverage. However, an Institute of Medicine report found that blacks received lower quality care than whites after controlling for health insurance, income, and disease severity.
To examine the effects of race on colorectal cancer outcomes within a single setting, the authors performed a retrospective cohort study that analyzed the cancer registry, billing, and medical records of 365 university hospital patients (175 blacks and 190 whites) diagnosed with stage II-IV colon cancer between 2000 and 2005. Racial differences in the quality (effectiveness and timeliness) of stage-specific colon cancer treatment (colectomy and chemotherapy) were examined after adjusting for socioeconomic status, health insurance coverage, sex, age, and marital status.
Blacks and whites had similar sociodemographic characteristics, tumor stage and site, quality of care, and health outcomes. Age and diagnostic stage were predictors of quality of care and mortality. Although few patients (5.8%) were uninsured, they were more likely to present at advanced stages (61.9% at stage IV) and die (76.2%) than privately insured and publicly insured patients (p = .002).
In a population without racial differences in socioeconomic status or insurance coverage, patients receive the same quality of care, regardless of racial distinction, and have similar health outcomes. Age, diagnostic stage, and health insurance coverage remained independently associated with mortality. Future studies of disparities in colon cancer treatment should examine sociocultural barriers to accessing appropriate care in various healthcare settings.
一些研究将癌症发病率和死亡率的种族差异归因于社会经济地位和健康保险覆盖范围的差异。然而，医学研究所的一份报告发现，在控制了健康保险、收入和疾病严重程度后，黑人接受的护理质量低于白人。
为了在单一环境中检查种族对结直肠癌结果的影响，作者进行了一项回顾性队列研究，分析了 2000 年至 2005 年间在大学医院诊断为 II-IV 期结肠癌的 365 名患者（175 名黑人，190 名白人）的癌症登记、计费和医疗记录。在调整了社会经济地位、健康保险覆盖范围、性别、年龄和婚姻状况后，研究了种族差异对特定阶段结肠癌治疗（结肠切除术和化疗）质量（有效性和及时性）的影响。
黑人和白人具有相似的社会人口统计学特征、肿瘤分期和部位、护理质量和健康结果。年龄和诊断阶段是护理质量和死亡率的预测因素。尽管少数患者（5.8%）没有保险，但他们比私人保险和公共保险患者更有可能处于晚期（61.9%处于 IV 期）并死亡（76.2%）（p =.002）。
在没有社会经济地位或保险覆盖范围种族差异的人群中，无论种族差异如何，患者都接受相同的护理质量，并具有相似的健康结果。年龄、诊断阶段和健康保险覆盖范围仍然与死亡率独立相关。未来对结肠癌治疗差异的研究应检查在各种医疗保健环境中获得适当护理的社会文化障碍。
