Gomez Scarlett Lin, Shariff-Marco Salma, Von Behren Julie, Kwan Marilyn L, Kroenke Candyce H, Keegan Theresa H M, Reynolds Peggy, Kushi Lawrence H
Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94538, USA.
Department of Health Research and Policy, School of Medicine, Stanford, 94305, CA, USA.
BMC Cancer. 2015 Oct 14;15:688. doi: 10.1186/s12885-015-1696-9.
Integrated health care delivery systems, with their comprehensive and integrated electronic medical records (EMR), are well-poised to conduct research that leverages the detailed clinical data within the EMRs. However, information regarding the representativeness of these clinical populations is limited, and thus the generalizability of research findings is uncertain.
Using data from the population-based California Cancer Registry, we compared age-adjusted distributions of patient and neighborhood characteristics for three groups of breast cancer patients: 1) those diagnosed within Kaiser Permanente Northern California (KPNC), 2) non-KPNC patients from NCI-designated cancer centers, and 3) those from all other hospitals.
KPNC patients represented 32 % (N = 36,109); cancer center patients represented 7 % (N = 7805); and all other hospitals represented 61 % (N = 68,330) of the total breast cancer patients from this geographic area during 1996-2009. Compared with cases from all other hospitals, KPNC had slightly fewer non-Hispanic Whites (70.6 % versus 74.4 %) but more Blacks (8.1 % versus 5.0 %), slightly more patients in the 50-69 age range and fewer in the younger and older age groups, a slightly lower proportion of in situ but higher proportion of stage I disease (41.6 % versus 38.9 %), were slightly less likely to reside in the lowest (4.2 % versus 6.5 %) and highest (36.2 % versus 39.0 %) socioeconomic status neighborhoods, and more likely to live in suburban metropolitan areas and neighborhoods with more racial/ethnic minorities. Cancer center patients differed substantially from patients from KPNC and all other hospitals on all characteristics assessed. All differences were statistically significant (p < .001).
Although much of clinical research discoveries are based in academic medical centers, patients from large, integrated medical centers are likely more representative of the underlying population, providing support for the generalizability of cancer research based on electronic data from these centers.
整合型医疗服务体系凭借其全面且整合的电子病历（EMR），非常适合开展利用电子病历中详细临床数据的研究。然而，关于这些临床人群代表性的信息有限，因此研究结果的可推广性尚不确定。
利用基于人群的加利福尼亚癌症登记处的数据，我们比较了三组乳腺癌患者的年龄调整后的患者特征和社区特征分布：1）在北加利福尼亚凯撒医疗集团（KPNC）确诊的患者；2）来自美国国立癌症研究所指定癌症中心的非KPNC患者；3）来自所有其他医院的患者。
1996 - 2009年期间，该地理区域的乳腺癌患者中，KPNC患者占32%（N = 36,109）；癌症中心患者占7%（N = 7805）；所有其他医院的患者占61%（N = 68,330）。与所有其他医院的病例相比，KPNC的非西班牙裔白人略少（70.6%对74.4%），但黑人更多（8.1%对5.0%），50 - 69岁年龄段的患者略多，而年轻和老年组的患者较少，原位癌比例略低但I期疾病比例较高（41.6%对38.9%），居住在社会经济地位最低（4.2%对6.5%）和最高（36.2%对39.0%）社区的可能性略小，更有可能居住在郊区大都市区以及种族/族裔少数群体较多的社区。癌症中心的患者在所有评估特征上与KPNC和所有其他医院的患者有很大差异。所有差异均具有统计学意义（p < 0.001）。
尽管许多临床研究发现都基于学术医疗中心，但来自大型整合医疗中心的患者可能更能代表潜在人群，这为基于这些中心电子数据的癌症研究的可推广性提供了支持。
