Alexander Melannie, Zhu Kangmin, Cullen Jennifer, Byrne Celia, Brown Derek, Shao Stephanie, Rusiecki Jennifer
Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Cancer Causes Control. 2019 Jun;30(6):627-635. doi: 10.1007/s10552-019-01163-5. Epub 2019 Apr 17.
In the U.S. general population, black men experience poorer survival after prostate cancer (CaP) diagnosis compared to white men, and findings may be impacted by unequal access to healthcare. The objective of the study is to investigate racial differences in overall survival (OS) among Department of Defense beneficiaries diagnosed with CaP.
A retrospective cohort study was conducted utilizing the Automated Central Tumor Registry within the Military Healthcare System, a system designed to provide equal access. Men diagnosed with primary prostate adenocarcinomas between 1990 and 2010 [n = 18,484; 24% Non-Hispanic black (NHB), 76% Non-Hispanic white (NHW)] were followed through 2013 for vital status. Unadjusted Kaplan-Meier estimation curves and multivariable Cox proportional hazards (PH) regression models were used to examine racial differences in OS.
Age-specific Kaplan-Meier analyses showed equivalent OS for NHW and NHB men in all age groups, except for 75+, where NHB had poorer OS (p = 0.0048). Multivariable Cox PH models revealed no significant differences in OS for race (HR 1.02; 95% CI 0.95-1.08), except in men aged ≥ 75 years, where NHB men had poorer OS (HR 1.27; 95% CI 1.08-1.49).
Findings suggest that in a healthcare system designed for equal access, disparities in OS among men diagnosed with CaP may not exist.
在美国普通人群中，前列腺癌（CaP）诊断后黑人男性的生存率低于白人男性，而研究结果可能受到医疗保健获取不平等的影响。本研究的目的是调查国防部受益人群中被诊断为CaP的患者在总生存期（OS）方面的种族差异。
利用军事医疗系统中的自动化中央肿瘤登记处进行了一项回顾性队列研究，该系统旨在提供平等的医疗服务。对1990年至2010年间被诊断为原发性前列腺腺癌的男性进行随访，直至2013年以了解其生命状态[n = 18484；24%为非西班牙裔黑人（NHB），76%为非西班牙裔白人（NHW）]。使用未调整的Kaplan-Meier估计曲线和多变量Cox比例风险（PH）回归模型来检验OS方面的种族差异。
特定年龄的Kaplan-Meier分析显示，除了75岁及以上年龄组外，所有年龄组的NHW和NHB男性的OS相当，在75岁及以上年龄组中，NHB的OS较差（p = 0.0048）。多变量Cox PH模型显示，种族在OS方面无显著差异（HR 1.02；95% CI 0.95 - 1.08），但在年龄≥75岁的男性中，NHB男性的OS较差（HR 1.27；95% CI 1.08 - 1.49）。
研究结果表明，在一个旨在提供平等医疗服务的医疗系统中，被诊断为CaP的男性在OS方面可能不存在差异。
