Weill Cornell Medicine, New York, NY, USA.
J Cancer Surviv. 2022 Feb;16(1):52-60. doi: 10.1007/s11764-021-01003-z. Epub 2021 Mar 4.
Many cancer survivors with co-morbid diabetes receive less diabetes management than their non-cancer counterparts. We sought to determine if racial/ethnic disparities exist in recommended diabetes care within 12 months of an incident breast, prostate, or colorectal cancer diagnosis. Because co-morbid diabetes decreases long-term survival, identifying predictors of guideline-concordant diabetes care is important.
Using the Surveillance, Epidemiology, and End Results cancer registry linked to Medicare claims, we included beneficiaries aged 67+ years with diabetes and incident, non-metastatic breast, prostate, or colorectal cancer between 2008 and 2013. Primary outcomes were diabetes care services 12 months after diagnosis: (1) HbA1c test, (2) eye exam, and (3) low-density lipoprotein (LDL) test. Using modified Poisson models with robust standard errors, we examined each outcome separately.
We included 34,643 Medicare beneficiaries with both diabetes and cancer. Mean age at diagnosis was 76.1 (SD 6.2), 47.2% were women; 35% had breast, 24% colorectal, and 41% prostate cancer. In the 12 months after incident cancer diagnosis, 82.4% received an HbA1c test, 55.3% received an eye exam, 77.8% had an LDL test, and 42.0% received all three tests. Compared to non-Hispanic Whites, Blacks were 3% (95% CI 0.95-0.98) less likely to receive a HbA1c test, 10% (95% CI 0.89-0.92) less likely to receive a LDL test, and 8% (95% 0.89-0.95) less likely to receive an exam eye. Blacks and Hispanics were 16% (95% CI 0.81-0.88) and 7% (0.88-0.98) less likely to receive all three tests, after accounting for confounders. Racial/ethnic differences persisted across cancer types.
Blacks and Hispanics with breast, prostate, and colorectal cancer and diabetes received less diabetes care after cancer diagnosis compared to non-Hispanic Whites. Differences were not explained by socio-economic factors or clinical need.
Our findings are concerning given the high prevalence of diabetes and poor cancer outcomes among racial/ethnic minorities. The next step in this line of inquiry is to determine why minorities are less likely to receive comprehensive diabetes care in order to develop targeted strategies to increase receipt of appropriate diabetes management for these vulnerable populations.
患有合并糖尿病的癌症幸存者接受的糖尿病管理少于非癌症患者。我们旨在确定在非转移性乳腺癌、前列腺癌或结直肠癌诊断后 12 个月内，是否存在与种族/民族有关的糖尿病护理方面的差异。因为合并糖尿病会降低长期生存率，所以确定符合指南的糖尿病护理的预测因素很重要。
我们使用监测、流行病学和最终结果癌症登记处与医疗保险索赔相关联，纳入了 2008 年至 2013 年期间年龄在 67 岁及以上、患有糖尿病且患有非转移性乳腺癌、前列腺癌或结直肠癌的受益人群。主要结局是在诊断后 12 个月内的糖尿病护理服务：（1）糖化血红蛋白（HbA1c）测试，（2）眼科检查，（3）低密度脂蛋白（LDL）测试。使用具有稳健标准误差的修正泊松模型，我们分别检查了每个结局。
我们纳入了 34643 名患有糖尿病和癌症的医疗保险受益人群。诊断时的平均年龄为 76.1（SD 6.2），47.2%为女性；35%患有乳腺癌，24%患有结直肠癌，41%患有前列腺癌。在非转移性癌症诊断后的 12 个月内，82.4%的人接受了 HbA1c 测试，55.3%的人接受了眼科检查，77.8%的人进行了 LDL 测试，42.0%的人接受了所有三项测试。与非西班牙裔白人相比，黑人接受 HbA1c 测试的可能性低 3%（95%CI 0.95-0.98），接受 LDL 测试的可能性低 10%（95%CI 0.89-0.92），接受眼科检查的可能性低 8%（95%CI 0.89-0.95）。在考虑了混杂因素后，黑人（95%CI 0.81-0.88）和西班牙裔（95%CI 0.88-0.98）接受所有三项测试的可能性分别低 16%和 7%。种族/民族差异在各种癌症类型中均存在。
与非西班牙裔白人相比，患有乳腺癌、前列腺癌和结直肠癌和糖尿病的黑人和西班牙裔在癌症诊断后接受的糖尿病护理较少。差异不能用社会经济因素或临床需要来解释。
鉴于少数族裔中糖尿病的高患病率和癌症结局不佳，我们的发现令人担忧。这一研究方向的下一步是确定为什么少数族裔接受全面的糖尿病管理的可能性较低，以便制定针对这些弱势群体的适当糖尿病管理目标策略。
