Noel Marcus, Fiscella Kevin
Department of Medicine Hematology and Oncology Division, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, New York.
Health Equity. 2019 Oct 29;3(1):532-540. doi: 10.1089/heq.2019.0057. eCollection 2019.
Pancreatic cancer remains a major health concern; in the next 2 years, it will become the second leading cause of cancer deaths in the United States. Health disparities in the treatment of pancreatic cancer exist across many disciplines, including race and ethnicity, socioeconomic status (SES), and insurance. This narrative review discusses what is known about these disparities, with the goal of highlighting targets for equity promoting interventions. We performed a narrative review of health disparities in pancreatic cancer spanning greater than ten areas, including epidemiology, treatment, and outcome, using the PubMed NIH database from 2000 to 2019 in the Unites States. African Americans (AAs) tend to present at diagnosis with later stage disease. AAs and Hispanics have lower rates of surgical resection, are more likely to be treated at low volume hospitals, and often experience higher rates of morbidity and mortality compared to white patients, although control for confounders is often limited. Insurance and SES also factor into the delivery of treatment for pancreatic cancer. Disparities by race and SES exist in the diagnosis and treatment of pancreatic cancer that are largely driven by race and SES. Improved understanding of underlying causes could inform interventions.
胰腺癌仍然是一个重大的健康问题;在未来两年内,它将成为美国癌症死亡的第二大主要原因。胰腺癌治疗中的健康差异存在于许多领域,包括种族和族裔、社会经济地位(SES)以及保险等方面。本叙述性综述讨论了关于这些差异的已知情况,目的是突出促进公平干预的目标。我们使用美国国立医学图书馆(NIH)的PubMed数据库,对2000年至2019年期间涵盖十个以上领域(包括流行病学、治疗和结局)的胰腺癌健康差异进行了叙述性综述。非裔美国人(AAs)在诊断时往往表现为疾病处于较晚期。与白人患者相比,非裔美国人和西班牙裔的手术切除率较低,更有可能在规模较小的医院接受治疗,并且发病率和死亡率通常更高,尽管对混杂因素的控制往往有限。保险和社会经济地位也影响着胰腺癌的治疗。在胰腺癌的诊断和治疗中,种族和社会经济地位方面的差异很大程度上是由种族和社会经济地位驱动的。对潜在原因的更好理解可为干预措施提供依据。