Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Ann Surg Oncol. 2012 Mar;19(3):722-7. doi: 10.1245/s10434-011-2087-3. Epub 2011 Sep 27.
Several factors, including race, age, stage, comorbid conditions, social support, and socioeconomic status, have been linked to the likelihood of a patient having surgery for early-stage non-small cell lung cancer (NSCLC). The aim of the present study is to determine the influence of race and health disparities on refusal of recommended potentially curative surgery.
The Surveillance, Epidemiology, and End Results (SEER) database was used to create a cohort of 62,514 patients diagnosed with stages I and II NSCLC between 1988 and 2002, of whom 51,938 were recommended for surgery. The outcome variable was refusal of recommended surgical treatment, while race was the key predictor variable. Potential confounders were adjusted for in the hierarchical generalized logistic regression analysis.
A majority was White (86%) and underwent surgery (81%). About 2% of Blacks (n = 109), 1.4% of Whites (n = 756), and 2.8% of "other" race individuals (n = 96) refused surgery. In the multivariable adjusted model, Blacks [odds ratio (OR) 1.95, 95% confidence interval (CI) 1.5, 2.3, P < 0.001] and those of "other" race (OR 2.03, 95% CI 1.5, 2.5, P < 0.001) had greater odds of refusing surgery than did Whites. Increasing age, male gender (OR 1.17, P = 0.031), and being unmarried (OR 2.1, P < 0.001) were other factors associated with higher odds of refusal. Significant county variations were also noted in refusal of surgery.
Blacks and "other" races are more likely to refuse recommended surgery for early-stage NSCLC compared with Whites. Future studies should focus on exploring potential reasons for refusal and developing communication interventions.
多种因素，包括种族、年龄、分期、合并症、社会支持和社会经济地位，与早期非小细胞肺癌（NSCLC）患者接受手术的可能性相关。本研究旨在确定种族和健康差异对拒绝推荐的潜在根治性手术的影响。
利用监测、流行病学和最终结果（SEER）数据库，创建了一个 1988 年至 2002 年间诊断为 I 期和 II 期 NSCLC 的 62514 例患者队列，其中 51938 例患者被推荐接受手术。因变量为拒绝推荐的手术治疗，而种族是关键预测变量。在分层广义逻辑回归分析中调整了潜在的混杂因素。
大多数患者为白人（86%）并接受了手术（81%）。约 2%的黑人（n=109）、1.4%的白人（n=756）和 2.8%的“其他”种族个体（n=96）拒绝了手术。在多变量调整模型中，黑人（比值比[OR]1.95，95%置信区间[CI]1.5，2.3，P<0.001）和“其他”种族个体（OR 2.03，95%CI 1.5，2.5，P<0.001）拒绝手术的可能性大于白人。年龄增长、男性（OR 1.17，P=0.031）和未婚（OR 2.1，P<0.001）是与更高拒绝手术可能性相关的其他因素。手术拒绝率也存在显著的县差异。
与白人相比，黑人及其他种族更有可能拒绝接受早期 NSCLC 的推荐手术。未来的研究应重点探讨拒绝手术的潜在原因，并制定沟通干预措施。
