Division of Gastrointestinal and General Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Center for Surgery and Public Health, Brigham and Woman's Hospital, Harvard Medical School, 1620 Tremont St., Boston, MA, 02120, USA.
J Gastrointest Surg. 2021 Jul;25(7):1847-1856. doi: 10.1007/s11605-020-04744-x. Epub 2020 Jul 28.
Racial disparities exist in patients with rectal cancer with respect to both treatment and survival. Minority-serving hospitals (MSHs) provide healthcare to a disproportionately large percent of minority patients in the USA. We examined the effects of rectal cancer treatment at MSH to understand drivers of these disparities.
The NCDB was queried (2004-2015), and patients diagnosed with stage II or III rectal adenocarcinoma were identified. Racial case mix distribution was calculated at the institutional level, and MSHs were defined as those within the top decile of Black and Hispanic patients. Logistic regression was used to identify predictors of receipt of standard of care treatment. Survival was assessed using the Kaplan-Meier method, and Cox proportional hazards models were used to evaluate adjusted risk of death. Analyses were clustered by facility.
A total of 68,842 patients met the inclusion criteria. Of these patients, 63,242 (91.9%) were treated at non-MSH, and 5600 (8.1%) were treated at MSH. In multivariable analysis, treatment at MSH (OR 0.70 95%CI 0.61-0.80 p < 0.001) and Black race (OR 0.75 95%CI 0.70-0.81 p < 0.001) were associated with significantly lower odds of receiving standard of care. In adjusted analysis, Black patients had a significantly higher risk of mortality (HR 1.20 95%CI 1.14-1.26 p < 0.001).
Treatment at MSH institutions and Black race were associated with significantly decreased odds of receipt of recommended standard therapy for locally advanced rectal adenocarcinoma. Survival was worse for Black patients compared to White patients despite adjustment for receipt of standard of care.
在美国，直肠癌患者在治疗和生存方面存在种族差异。少数族裔服务医院（MSH）为美国少数民族患者提供了不成比例的大量医疗服务。我们研究了 MSH 治疗直肠癌的效果，以了解造成这些差异的驱动因素。
我们查询了 NCDB（2004-2015 年），并确定了 II 期或 III 期直肠腺癌患者。在机构层面计算了种族病例组合分布，将黑人患者和西班牙裔患者比例最高的前十分位数的医院定义为 MSH。采用 logistic 回归确定接受标准治疗的预测因素。采用 Kaplan-Meier 法评估生存情况，采用 Cox 比例风险模型评估调整后的死亡风险。分析按机构进行聚类。
共有 68842 名患者符合纳入标准。其中，63242 名（91.9%）患者在非 MSH 治疗，5600 名（8.1%）患者在 MSH 治疗。多变量分析显示，MSH 治疗（OR 0.70，95%CI 0.61-0.80，p<0.001）和黑人种族（OR 0.75，95%CI 0.70-0.81，p<0.001）与接受标准治疗的可能性显著降低相关。在调整分析中，黑人患者的死亡风险显著更高（HR 1.20，95%CI 1.14-1.26，p<0.001）。
在 MSH 机构接受治疗和黑人种族与接受局部晚期直肠腺癌推荐标准治疗的可能性显著降低相关。尽管调整了标准治疗的接受情况，但与白人患者相比，黑人患者的生存率更差。
