Lamkaddem M, Elferink M A G, Seeleman M C, Dekker E, Punt C J A, Visser O, Essink-Bot M L
Department of Public Health, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
Netherlands Comprehensive Cancer Care Organisation, Utrecht, The Netherlands.
BMC Cancer. 2017 May 4;17(1):312. doi: 10.1186/s12885-017-3241-5.
Ethnic differences in colon cancer (CC) care were shown in the United States, but results are not directly applicable to European countries due to fundamental healthcare system differences. This is the first study addressing ethnic differences in treatment and survival for CC in the Netherlands.
Data of 101,882 patients diagnosed with CC in 1996-2011 were selected from the Netherlands Cancer Registry and linked to databases from Statistics Netherlands. Ethnic differences in lymph node (LN) evaluation, anastomotic leakage and adjuvant chemotherapy were analysed using stepwise logistic regression models. Stepwise Cox regression was used to examine the influence of ethnic differences in adjuvant chemotherapy on 5-year all-cause and colorectal cancer-specific survival.
Adequate LN evaluation was significantly more likely for patients from 'other Western' countries than for the Dutch (OR 1.09; 95% CI 1.01-1.16). 'Other Western' patients had a significantly higher risk of anastomotic leakage after resection (OR 1.24; 95% CI 1.05-1.47). Patients of Moroccan origin were significantly less likely to receive adjuvant chemotherapy (OR 0.27; 95% CI 0.13-0.59). Ethnic differences were not fully explained by differences in socioeconomic and hospital-related characteristics. The higher 5-year all-cause mortality of Moroccan patients (HR 1.64; 95% CI 1.03-2.61) was statistically explained by differences in adjuvant chemotherapy receipt.
These results suggest the presence of ethnic inequalities in CC care in the Netherlands. We recommend further analysis of the role of comorbidity, communication in patient-provider interaction and patients' health literacy when looking at ethnic differences in treatment for CC.
在美国已显示出结肠癌（CC）护理方面的种族差异，但由于基本医疗保健系统的差异，这些结果不能直接应用于欧洲国家。这是第一项针对荷兰CC治疗和生存方面种族差异的研究。
从荷兰癌症登记处选取1996年至2011年期间诊断为CC的101,882名患者的数据，并与荷兰统计局的数据库相链接。使用逐步逻辑回归模型分析淋巴结（LN）评估、吻合口漏和辅助化疗方面的种族差异。采用逐步Cox回归分析辅助化疗方面的种族差异对5年全因生存率和结直肠癌特异性生存率的影响。
“其他西方”国家的患者进行充分LN评估的可能性显著高于荷兰患者（比值比[OR] 1.09；95%置信区间[CI] 1.01 - 1.16）。“其他西方”患者切除术后吻合口漏的风险显著更高（OR 1.24；95% CI 1.05 - 1.47）。摩洛哥裔患者接受辅助化疗的可能性显著更低（OR 0.27；95% CI 0.13 - 0.59）。社会经济和医院相关特征的差异并不能完全解释种族差异。摩洛哥患者较高的5年全因死亡率（风险比[HR] 1.64；95% CI 1.03 - 2.61）在统计学上可由辅助化疗接受情况的差异来解释。
这些结果表明荷兰在CC护理方面存在种族不平等。我们建议在研究CC治疗的种族差异时，进一步分析合并症的作用、医患互动中的沟通以及患者的健康素养。
