Department of Urology, University of Minnesota, Minneapolis, Minnesota.
Department of Urology, University of Minnesota, Minneapolis, Minnesota.
Am J Prev Med. 2018 Nov;55(5 Suppl 1):S14-S21. doi: 10.1016/j.amepre.2018.05.012.
Disparities in healthcare outcomes between races have been extensively described; however, studies fail to characterize the contribution of differences in distribution of covariates between groups and the impact of discrimination. This study aims to characterize the degree to which clinicodemographic factors and unmeasured confounders are contributing to any observed disparities between non-Hispanic white and black males on surgical outcomes after major urologic cancer surgery.
Non-Hispanic white and black males undergoing radical cystectomy, nephrectomy, or prostatectomy for cancer in the American College of Surgeons National Surgical Quality Improvement Program database from 2007 to 2016 were included in this analysis. The outcome of interest was Clavien III-V complications. Analysis was conducted in 2017 using the Peters-Belson method to compare the disparity in outcomes while adjusting for 13 important demographic and clinical characteristics.
Of the 15,693 cases included with complete data, 13.0% (n=2,040) were black. There was a significantly increased rate of unadjusted Clavien III and V complications between white versus black males for radical cystectomy (21.9% vs 10.1%, p=0.005); nephrectomy (6.4% vs 3.9%, p=0.028); and radical prostatectomy (2.3% vs 1.6%, p=0.046). Adjusting for differences in age, BMI, American Society of Anesthesiologists score, functional status, smoking history, and comorbidities including diabetes, chronic obstructive pulmonary disease, heart failure, renal failure, bleeding disorder, steroid use, unintentional weight loss, and hypertension between the groups could not explain the disparity in complications after radical cystectomy; the unexplained discrepancy was an absolute excess of 11.8% (p=0.01) in black males. There was an unexplained excess of complications in black males undergoing radical prostatectomy and nephrectomy but neither reached statistical significance.
Black males undergoing radical cystectomy for cancer experienced higher complication rates than white males. Unexplained differences between the black and white males significantly contributed to the disparity in outcomes, which suggests that unmeasured factors, such as the quality of surgical or perioperative care, are playing a considerable role in the observed inequality.
This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.
种族间医疗保健结果的差异已得到广泛描述；然而，研究未能描述组间协变量分布差异和歧视的影响在多大程度上促成了非西班牙裔白人和黑人男性在接受主要泌尿科癌症手术后的手术结果方面的任何观察到的差异。
本分析纳入了 2007 年至 2016 年期间在美国外科医师学院国家外科质量改进计划数据库中接受根治性膀胱切除术、肾切除术或前列腺切除术治疗癌症的非西班牙裔白人和黑人男性。感兴趣的结果是 Clavien III-V 并发症。2017 年使用彼得斯-贝尔森方法进行分析，同时调整 13 个重要的人口统计学和临床特征来比较结果差异。
在纳入的 15693 例具有完整数据的病例中，13.0%（n=2040）为黑人。与白人男性相比，黑人男性接受根治性膀胱切除术的未经调整的 Clavien III 和 V 并发症发生率显著增加（21.9%比 10.1%，p=0.005）；肾切除术（6.4%比 3.9%，p=0.028）；根治性前列腺切除术（2.3%比 1.6%，p=0.046）。调整组间年龄、BMI、美国麻醉医师协会评分、功能状态、吸烟史以及合并症（包括糖尿病、慢性阻塞性肺疾病、心力衰竭、肾衰竭、出血性疾病、类固醇使用、非故意体重减轻和高血压）之间的差异后，不能解释根治性膀胱切除术后并发症的差异；未解释的差异为黑人男性绝对多余 11.8%（p=0.01）。黑人男性接受根治性前列腺切除术和肾切除术的并发症有未解释的过多，但均未达到统计学意义。
接受根治性膀胱切除术治疗癌症的黑人男性比白人男性的并发症发生率更高。黑人男性和白人男性之间未解释的差异显著导致了结果的差异，这表明未测量的因素，如手术或围手术期护理的质量，在观察到的不平等中起着相当大的作用。
本文是由美国国立卫生研究院赞助的题为“非裔美国男性健康：研究、实践和政策影响”的补充的一部分。
