Department of Surgery, Boston University/Boston Medical Center, USA.
Department of Surgery, Boston University/Boston Medical Center, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA.
HPB (Oxford). 2021 Jun;23(6):854-860. doi: 10.1016/j.hpb.2020.12.011. Epub 2021 Jan 19.
There is a long history of segregation in the U.S.A with enduring impacts on cancer outcomes today. We evaluated the impact of segregation on racial disparities in Hepatocellular Carcinoma (HCC) treatment and outcomes.
We obtained data on black and white patients with HCC from the SEER program (2005-2015) within the 100 most populous participating counties. Our exposure was the index of dissimilarity (IoD), a validated measure of segregation. Outcomes were overall survival, advanced stage at diagnosis (Stage III/IV) and surgery for localized disease (Stage I/II). Cancer-specific survival was assessed using Kaplan-Meier estimates.
Black patients had a 1.18 times increased risk (95%CI 1.14,1.22) of presenting at advanced stage as compared to white patients and these disparities disappeared at low levels of segregation. In the highest quartile of IoD, black patients had a significantly lower survival than white (17 months vs 27 months, p < 0.001), and this difference disappeared at the lowest quartile of IoD.
Our data illustrate that structural racism in the form racial segregation has a significant impact on racial disparities in the treatment of HCC. Urban and health policy changes can potentially reduce disparities in HCC outcomes.
美国存在长期的种族隔离历史，对当今的癌症结局仍有持久影响。我们评估了隔离对肝细胞癌（HCC）治疗和结局的种族差异的影响。
我们从 SEER 计划（2005-2015 年）中获取了来自 100 个人口最多的参与县的黑人和白人 HCC 患者的数据。我们的暴露因素是不相似指数（IoD），这是一种经过验证的隔离衡量标准。结局是总生存、诊断时的晚期（III/IV 期）和局部疾病的手术（I/II 期）。使用 Kaplan-Meier 估计评估癌症特异性生存。
与白人患者相比，黑人患者在诊断时处于晚期的风险增加了 1.18 倍（95%CI 1.14,1.22），而在隔离程度较低时，这些差异就消失了。在 IoD 的最高四分位数中，黑人患者的生存明显低于白人（17 个月比 27 个月，p<0.001），而在 IoD 的最低四分位数中，这种差异就消失了。
我们的数据表明，以种族隔离形式存在的结构性种族主义对 HCC 治疗中的种族差异有重大影响。城市和卫生政策的改变可能会减少 HCC 结局方面的差异。
