Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Med Care. 2011 Feb;49(2):207-14. doi: 10.1097/MLR.0b013e3182019123.
To determine whether (1) black and white women with endometrial cancer were treated by different surgical specialties and in different types of hospitals and (2) differences in specialty and hospital type contributed to racial differences in survival.
Retrospective cohort study of 12,307 women aged 65 years and older who underwent surgical treatment of endometrial cancer between 1991 and 1999 in the 11 Surveillance Epidemiology and End Results registries.
Black women were more likely to have a gynecologic oncologist to perform their surgery and to be treated at hospitals that were higher volume, larger, teaching, National Cancer Institute centers, urban, and where a greater proportion of the surgeries were performed by a gynecologic oncologist. In unadjusted models, black women were over twice as likely as white women who died because of cancer (hazards ratio [HR]: 2.33), but nearly all of the initial racial difference in survival was explained by differences in cancer stage, and grade as well as age and comorbidities at presentation (adjusted HR: 1.10). Surgical specialty was not associated with survival and, of the hospital characteristics studied, only surgical volume was associated with survival (P < 0.005). Adjusting for hospital characteristics did not change the racial difference in survival (HR: 1.10). Adjustment for the specific hospital where the woman was treated eliminated the association between race and surgeon specialty and slightly widened the residual racial difference in survival (HR: 1.23 vs. 1.10).
In contrast to several studies suggesting that blacks with breast cancer, colon cancer, or cardiovascular disease are treated in hospitals with lower quality indicators, black women diagnosed with endometrial cancer in Surveillance Epidemiology and End Results regions between 1991 and 1999 were more likely to be treated by physicians with advanced training and in high volume, large, urban, teaching hospitals. However, except for a modest association with hospital surgical volume, these provider and hospital characteristics were largely unrelated to survival for women with endometrial cancer. The great majority of the difference in survival was explained by differences in tumor and clinical characteristics at presentation.
确定（1）患有子宫内膜癌的黑人和白人女性是否接受不同的外科专业治疗以及在不同类型的医院接受治疗，以及（2）专业和医院类型的差异是否导致生存方面的种族差异。
对 1991 年至 1999 年间在 11 个监测、流行病学和最终结果登记处接受手术治疗子宫内膜癌的 12307 名 65 岁及以上女性进行回顾性队列研究。
黑人女性更有可能让妇科肿瘤学家为其进行手术，并在手术量较大、规模较大、教学、美国国立癌症研究所中心、城市、以及更多手术由妇科肿瘤学家进行的医院接受治疗。在未调整的模型中，黑人女性死于癌症的可能性是白人女性的两倍多（风险比[HR]：2.33），但几乎所有最初的生存种族差异都可以通过癌症分期、分级以及发病时的年龄和合并症来解释（调整后的 HR：1.10）。外科专业与生存无关，在所研究的医院特征中，只有手术量与生存有关（P <0.005）。调整医院特征并未改变生存方面的种族差异（HR：1.10）。调整女性接受治疗的具体医院并未改变种族与外科医生专业之间的关联，但略微扩大了生存方面的剩余种族差异（HR：1.23 与 1.10）。
与几项表明患有乳腺癌、结肠癌或心血管疾病的黑人在医疗质量指标较低的医院接受治疗的研究相反，在 1991 年至 1999 年间在监测、流行病学和最终结果地区被诊断患有子宫内膜癌的黑人女性更有可能接受具有高级培训的医生以及在大手术量、规模较大、城市、教学医院接受治疗。然而，除了与医院手术量有适度关联外，这些医生和医院特征与子宫内膜癌女性的生存基本无关。生存差异的绝大部分是由于就诊时肿瘤和临床特征的差异所致。
