Department of Neurological Surgery, Lois Pope Life Center, University of Miami Miller School of Medicine, Jackson Health System, Miami, FL, USA.
Department of Neurologic Surgery, 200 First St. SW, Rochester, MN, 55905, USA.
J Neurooncol. 2020 May;147(3):711-720. doi: 10.1007/s11060-020-03480-1. Epub 2020 Mar 31.
Access to treatment for glioblastoma (GBM) can be impacted by multiple demographic parameters. Barriers specific to the Hispanic population of the United States (US) are not fully understood. Therefore, the aim of this study was to elucidate geographic disparities for access to GBM treatment in the US Hispanic population.
All GBM patients with known Hispanic ethnicity status (and Caucasian race) in the US National Cancer Database (NCDB) between the years 2005-2016 were retrospectively reviewed. Treatment statuses of surgical resection, chemotherapy, radiation therapy and triple therapy (resection, chemotherapy and radiation) were summarized, and analyzed by comparison and regression analyses over US Census regions.
A total cohort size of 40,232 Caucasian GBM patients were included, with 3,111 (8%) identifying as Hispanic. The odds of treatment by chemotherapy (OR 0.78, P < 0.01), radiation therapy (OR 0.82, P < 0.01) and triple therapy (OR 0.84, P < 0.01) were all significantly lower in the Hispanic group versus non-Hispanic group. The odds of being treated in the Hispanic group were significantly lower in multiple Census regions with respect to surgical resection (New England, OR 0.51; Mountain, OR 0.68), chemotherapy (East North Central, OR 0.77; Middle Atlantic, OR 0.71; Pacific, OR 0.77), radiation therapy (Middle Atlantic, OR 0.77) and triple therapy (New England, OR 0.49; Middle Atlantic, OR 0.87; Pacific, OR 0.84). Significant barriers to triple therapy in the Hispanic group within these regions were older age (OR 0.97; P < 0.01), treatment in a community facility (OR 0.85, P = 0.03), lack of insurance (OR 0.71, P = 0.03), yearly income < $40,227 (OR 0.69, P < 0.01), low education levels (OR 0.75, P = 0.03) and presence of co-morbidity (OR 0.82; P < 0.01).
Currently in the US, there exists heterogenous geographic disparities for Hispanic GBM patients to access different treatments compared to non-Hispanic patients. Multiple circumstances can influence access to treatment within the Hispanic community of these regions, and greater investigation with more granularity required to reveal mechanisms in which these disparities may be addressed in the future.
胶质母细胞瘤（GBM）的治疗机会可能受到多种人口统计学参数的影响。美国西班牙裔人群特有的障碍尚未得到充分理解。因此，本研究旨在阐明美国西班牙裔人群接受 GBM 治疗的地理差异。
回顾性分析了美国国家癌症数据库（NCDB）中 2005-2016 年间已知西班牙裔种族的所有 GBM 患者。总结了手术切除、化疗、放疗和三联治疗（切除、化疗和放疗）的治疗情况，并通过与美国人口普查区的比较和回归分析进行了分析。
共纳入 40232 例白人 GBM 患者，其中 3111 例（8%）为西班牙裔。与非西班牙裔组相比，接受化疗（OR 0.78，P<0.01）、放疗（OR 0.82，P<0.01）和三联治疗（OR 0.84，P<0.01）的几率均显著降低。与手术切除（新英格兰，OR 0.51；山区，OR 0.68）、化疗（东中北部，OR 0.77；大西洋中部，OR 0.71；太平洋，OR 0.77）、放疗（大西洋中部，OR 0.77）和三联治疗（新英格兰，OR 0.49；大西洋中部，OR 0.87；太平洋，OR 0.84）相比，西班牙裔组在多个普查区接受治疗的几率明显较低。在这些地区，西班牙裔组接受三联治疗的显著障碍是年龄较大（OR 0.97；P<0.01）、在社区机构接受治疗（OR 0.85，P=0.03）、缺乏保险（OR 0.71，P=0.03）、年收入<40227 美元（OR 0.69，P<0.01）、教育程度较低（OR 0.75，P=0.03）和合并症（OR 0.82；P<0.01）。
目前在美国，与非西班牙裔患者相比，西班牙裔 GBM 患者获得不同治疗的地理差异存在异质性。多种情况可能会影响这些地区西班牙裔社区的治疗机会，需要更细致的研究来揭示未来解决这些差异的机制。
