Naik Gurudatta, Akinyemiju Tomi
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
Cancer Epidemiol. 2017 Feb;46:73-79. doi: 10.1016/j.canep.2016.12.001. Epub 2017 Jan 3.
This paper aims to determine whether racial disparities exist in hospitalization outcomes among African-American and White hospitalized prostate cancer patients in the United States. We evaluated racial differences among matched groups of patients in post-operative complications, hospital length of stay and in-hospital mortality.
We identified a total of 183,856 men aged 40 years and older with a primary diagnosis of prostate cancer, of which 58,701 underwent prostatectomy, through the Nationwide Inpatient Sample, and matched all African-American patients with White patients on: 1) Demographics, 2) Demographics+Clinical presentation and 3) Demographics+Clinical presentation+Treatment. Multivariable regression analyses were conducted in SAS and estimates were reported with 95% confidence intervals.
African-American patients were more likely to be admitted with metastatic disease (24.8%) compared with White patients matched on demographics (17.9%), and demographics+presentation (23.6%). However, 23.9% of African-American patients received surgery compared with 38.2% and 34.2% of Whites matched on demographics and demographics+presentation, respectively. White patients had lower in-hospital mortality compared with African-American patients matched on demographics (OR: 0.72, 95% CI: 0.66-0.79), demographics+presentation (OR: 0.88, 95% CI: 0.81-0.96), but was no longer significantly lower when matched on demographics, presentation and treatment (OR: 0.92, 95% CI: 0.85-1.00).
There were significant racial differences in outcomes among prostate cancer patients within the inpatient setting, even after accounting for demographic and presentation differences.
本文旨在确定在美国住院的非裔美国人和白人前列腺癌患者的住院治疗结果中是否存在种族差异。我们评估了匹配患者组在术后并发症、住院时间和院内死亡率方面的种族差异。
我们通过全国住院患者样本，识别出总共183,856名年龄在40岁及以上、初步诊断为前列腺癌的男性，其中58,701人接受了前列腺切除术，并将所有非裔美国患者与白人患者在以下方面进行匹配：1）人口统计学特征，2）人口统计学特征+临床表现，以及3）人口统计学特征+临床表现+治疗。在SAS中进行多变量回归分析，并报告95%置信区间的估计值。
与在人口统计学特征上匹配的白人患者（17.9%）以及在人口统计学特征+临床表现上匹配的白人患者（23.6%）相比，非裔美国患者更有可能因转移性疾病入院（24.8%）。然而，23.9%的非裔美国患者接受了手术，而在人口统计学特征上匹配的白人患者这一比例为38.2%，在人口统计学特征+临床表现上匹配的白人患者这一比例为34.2%。与在人口统计学特征上匹配的非裔美国患者相比，白人患者的院内死亡率较低（比值比：0.72，95%置信区间：0.66 - 0.79），在人口统计学特征+临床表现上匹配时也是如此（比值比：0.88，95%置信区间：0.81 - 0.96），但在人口统计学特征、临床表现和治疗都匹配时，白人患者的院内死亡率不再显著低于非裔美国患者（比值比：0.92，95%置信区间：0.85 - 1.00）。
即使在考虑了人口统计学特征和临床表现差异之后，住院前列腺癌患者的治疗结果仍存在显著的种族差异。
