Efird Jimmy T, Landrine Hope, Shiue Kristin Y, O'Neal Wesley T, Podder Tarun, Rosenman Julian G, Biswas Tithi
Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC 27834 USA ; Leo Jenkins Cancer Center, Brody School of Medicine, East Carolina University, Greenville, NC USA.
Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC 27834 USA.
Springerplus. 2014 Dec 3;3:710. doi: 10.1186/2193-1801-3-710. eCollection 2014.
The purpose of this study was to determine whether African-American lung cancer patients are diagnosed at a later stage than white patients, regardless of insurance type. The relationship between race and stage at diagnosis by insurance type was assessed using a Poisson regression model, with relative risk as the measure of association. The setting of the study was a large tertiary care cancer center located in the southeastern United States. Patients who were diagnosed with lung cancer between 2001 and 2010 were included in the study. A total of 717 (31%) African-American and 1,634 (69%) white lung cancer patients were treated at our facility during the study period. Adjusting for age, sex, and smoking-related histology, African-American patients were diagnosed at a statistically significant later stage (III/IV versus I/II) than whites for all insurance types, with the exception of Medicaid. Our results suggest that equivalent insurance coverage may not ensure equal presentation of stage between African-American and white lung cancer patients. Future research is needed to determine whether other factors such as treatment delays, suboptimal preventive care, inappropriate specialist referral, community segregation, and a lack of patient trust in health care providers may explain the continuing racial disparities observed in the current study.
本研究的目的是确定非裔美国肺癌患者是否比白人患者诊断时分期更晚，而不考虑保险类型。使用泊松回归模型评估按保险类型划分的种族与诊断分期之间的关系，以相对风险作为关联度量。该研究的地点是位于美国东南部的一家大型三级护理癌症中心。2001年至2010年间被诊断为肺癌的患者纳入研究。在研究期间，共有717名（31%）非裔美国肺癌患者和1634名（69%）白人肺癌患者在我们机构接受治疗。在调整年龄、性别和吸烟相关组织学因素后，除医疗补助保险外，所有保险类型的非裔美国患者诊断时分期（III/IV期与I/II期相比）均显著晚于白人。我们的结果表明，同等的保险覆盖范围可能无法确保非裔美国和白人肺癌患者在分期方面得到平等对待。需要进一步研究以确定其他因素，如治疗延迟、预防性医疗服务欠佳、专科转诊不当、社区隔离以及患者对医疗服务提供者缺乏信任等，是否可以解释本研究中观察到的持续存在的种族差异。
