Elferink Marloes A G, Lamkaddem Majda, Dekker Evelien, Tanis Pieter J, Visser Otto, Essink-Bot Marie-Louise
1 Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands 2 Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands 3 Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands 4 Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Dis Colon Rectum. 2016 Jun;59(6):513-9. doi: 10.1097/DCR.0000000000000585.
Ethnic inequalities in colorectal cancer care were reported previously in the United States. Studies specifically reporting on ethnic inequalities in rectal cancer care are limited.
This study aimed to explore potential ethnic inequalities in rectal cancer care in the Netherlands.
This was a nationwide, population-based observational study.
The study linked data of the Netherlands Cancer Registry with the Dutch population registry and the Social Statistics Database of Statistics Netherlands. Data were analyzed using stepwise multivariable logistic regression models.
All of the patients diagnosed with rectal carcinoma in 2003-2011 in the Netherlands (N = 27,159) were included.
We analyzed 2 rectal cancer treatment indicators (preoperative radiotherapy and sphincter-sparing surgery) and 2 indicators of short-term outcome of rectal cancer surgery (anastomotic leakage and 30-day postoperative mortality).
Patients of Western non-Dutch and non-Western origin with rectal cancer were significantly younger and had a higher tumor stage than ethnic Dutch patients. Considering preoperative radiotherapy, anastomotic leakage, and 30-day postoperative mortality, no ethnic inequalities were detected. After adjustment for age, sex, disease characteristics, and socioeconomic status, Western non-Dutch and non-Western patients were significantly more likely to receive sphincter-sparing surgery than ethnic Dutch patients (OR = 1.27 (95% CI, 1.04-1.55) and OR = 1.57 (95% CI, 1.02-2.42)).
This study was limited by the relatively low numbers of non-Dutch patients with rectal cancer.
Non-Dutch ethnic origin was associated with a higher rate of sphincter-sparing surgery. The absence of ethnic inequalities in preoperative radiotherapy, anastomotic leakage, and 30-day postoperative mortality suggests that ethnic minority patients have similar chances of optimal rectal cancer care outcomes as Dutch patients.
此前美国曾报道过结直肠癌护理中的种族不平等现象。专门报道直肠癌护理中种族不平等现象的研究有限。
本研究旨在探讨荷兰直肠癌护理中潜在的种族不平等现象。
这是一项基于全国人口的观察性研究。
该研究将荷兰癌症登记处的数据与荷兰人口登记处以及荷兰统计局的社会统计数据库相链接。使用逐步多变量逻辑回归模型对数据进行分析。
纳入了2003年至2011年在荷兰被诊断为直肠癌的所有患者（N = 27159）。
我们分析了2项直肠癌治疗指标（术前放疗和保留括约肌手术）以及2项直肠癌手术短期结局指标（吻合口漏和术后30天死亡率）。
患有直肠癌的非荷兰西方裔和非西方裔患者明显比荷兰裔患者年轻，且肿瘤分期更高。在考虑术前放疗、吻合口漏和术后30天死亡率方面，未发现种族不平等现象。在对年龄、性别、疾病特征和社会经济地位进行调整后，非荷兰西方裔和非西方裔患者比荷兰裔患者接受保留括约肌手术的可能性显著更高（比值比 = 1.27（95%置信区间，1.04 - 1.55）和比值比 = 1.57（95%置信区间，1.02 - 2.42））。
本研究受到直肠癌非荷兰患者相对数量较少的限制。
非荷兰种族出身与更高的保留括约肌手术率相关。术前放疗、吻合口漏和术后30天死亡率方面不存在种族不平等现象，这表明少数族裔患者与荷兰患者在直肠癌最佳护理结局方面有相似的机会。
