University of Edinburgh, Edinburgh EH8 9AG, UK.
J Epidemiol Community Health. 2010 Feb;64(2):117-23. doi: 10.1136/jech.2008.083816.
Ethnic disparities in cancer survival have been documented in many populations and cancer types. The causes of these inequalities are not well understood but may include disease and patient characteristics, treatment differences and health service factors. Survival was compared in a cohort of Maori (Indigenous) and non-Maori New Zealanders with colon cancer, and the contribution of demographics, disease characteristics, patient comorbidity, treatment and healthcare factors to survival disparities was assessed.
Maori patients diagnosed as having colon cancer between 1996 and 2003 were identified from the New Zealand Cancer Registry and compared with a randomly selected sample of non-Maori patients. Clinical and outcome data were obtained from medical records, pathology reports and the national mortality database. Cancer-specific survival was examined using Kaplan-Meier survival curves and Cox hazards modelling with multivariable adjustment.
301 Maori and 328 non-Maori patients with colon cancer were compared. Maori had a significantly poorer cancer survival than non-Maori (hazard ratio (HR)=1.33, 95% CI 1.03 to 1.71) that was not explained by demographic or disease characteristics. The most important factors contributing to poorer survival in Maori were patient comorbidity and markers of healthcare access, each of which accounted for around a third of the survival disparity. The final model accounted for almost all the survival disparity between Maori and non-Maori patients (HR=1.07, 95% CI 0.77 to 1.47).
Higher patient comorbidity and poorer access and quality of cancer care are both important explanations for worse survival in Maori compared with non-Maori New Zealanders with colon cancer.
在许多人群和癌症类型中，都有癌症生存方面的种族差异的记录。这些不平等的原因尚不清楚，但可能包括疾病和患者特征、治疗差异以及卫生服务因素。比较了一组毛利人（土著）和新西兰非毛利人结肠癌患者的生存情况，并评估了人口统计学、疾病特征、患者合并症、治疗和医疗保健因素对生存差异的贡献。
从新西兰癌症登记处确定了 1996 年至 2003 年间被诊断患有结肠癌的毛利患者，并与随机选择的非毛利患者样本进行了比较。临床和结局数据来自病历、病理报告和国家死亡率数据库。使用 Kaplan-Meier 生存曲线和 Cox 风险模型进行多变量调整后，评估了癌症特异性生存情况。
比较了 301 名毛利人和 328 名非毛利人结肠癌患者。毛利人的癌症生存率明显低于非毛利人（风险比（HR）=1.33，95%置信区间 1.03 至 1.71），这不能用人口统计学或疾病特征来解释。导致毛利人生存状况较差的最重要因素是患者合并症和医疗保健获取的标志物，这两个因素各占生存差异的约三分之一。最终模型几乎解释了毛利人和非毛利人结肠癌患者之间所有的生存差异（HR=1.07，95%置信区间 0.77 至 1.47）。
与新西兰非毛利人结肠癌患者相比，毛利人患者的合并症更高，以及获得和癌症治疗质量更差，这两者都是毛利人患者生存状况较差的重要解释。
