Division of Biostatistics and Epidemiology, Department of Medicine, Medical University of South Carolina, Charleston, 29425-8350, USA.
Community Dent Oral Epidemiol. 2012 Feb;40(1):80-8. doi: 10.1111/j.1600-0528.2011.00638.x. Epub 2011 Aug 24.
To investigate the impact of race on the likelihood of patients being recommended for surgery after a diagnosis of oral and oropharyngeal cancer.
A total of 68,445 cases of oral and oropharyngeal cancer were extracted from the 1988 to 2005 Surveillance, Epidemiology, and End Results (SEER) database. County-level rurality data and income data were merged using the US Department of Agriculture Rural-Urban Continuum Codes dataset and US Census Bureau Small Area Income & Poverty Estimates dataset. We used logistic regression analyses to investigate the impact of race on being recommended to surgery for oral and oropharyngeal cancer, adjusting for demographic, socioeconomic, and clinical factors. Stratified analyses were further conducted by tumor site and rural/urban status.
Recommendation to surgery varied significantly by race, with black patients less likely than white patients to be recommended to surgery for their oral and oropharyngeal cancer. The racial difference in recommendation to surgery varied significantly by age, geography, and tumor subsite. Racial disparities are most evident in lip and buccal cancer from rural areas (OR, 4.4; 95% CI, 2.6-7.5); and least evident in oropharyngeal cancer from urban areas (OR, 1.2; 95% CI, 1.1-1.3). The magnitude of the racial disparity is attenuated with increasing age.
We observed substantial racial disparities in surgery recommendation for oral and oropharyngeal cancer in the United States. Our results suggest the need to improve accessibility to better health care in racial minority groups, particularly in rural areas, and call for individual and institutional efforts to avoid physician bias related to the patient's sociodemographic characteristics in healthcare service.
调查种族对口腔和口咽癌患者接受手术治疗可能性的影响。
从 1988 年至 2005 年的监测、流行病学和最终结果（SEER）数据库中提取了 68445 例口腔和口咽癌病例。使用美国农业部农村-城市连续统一体代码数据集和美国人口普查局小区域收入和贫困估计数据集合并县一级的农村/城市数据和收入数据。我们使用逻辑回归分析调查种族对口咽癌手术治疗建议的影响，同时调整了人口统计学、社会经济和临床因素。通过肿瘤部位和城乡状况进一步进行分层分析。
手术治疗建议因种族而异，黑人患者接受口腔和口咽癌手术治疗的可能性低于白人患者。手术治疗建议的种族差异在年龄、地理位置和肿瘤亚部位方面存在显著差异。在农村地区的唇和颊癌中，种族差异最为明显（OR，4.4；95%CI，2.6-7.5）；在城市地区的口咽癌中，种族差异最小（OR，1.2；95%CI，1.1-1.3）。随着年龄的增长，种族差异的幅度减小。
我们观察到美国口腔和口咽癌手术治疗建议存在显著的种族差异。我们的结果表明，需要改善少数族裔群体，特别是农村地区的基本医疗保健可及性，并呼吁个人和机构努力避免医生因患者的社会人口特征而产生与医疗服务相关的偏见。
