Murtha Cancer Center/Research Program, the Department of Surgery and the Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, and the Gynecologic Cancer Center of Excellence, Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, the Walter Reed National Military Medical Center, and the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.
Obstet Gynecol. 2021 Apr 1;137(4):629-640. doi: 10.1097/AOG.0000000000004325.
To compare receipt of National Comprehensive Cancer Network Guideline-adherent treatment for gynecologic cancers, inclusive of uterine, cervical, and ovarian cancer, between non-Hispanic White women and racial-ethnic minority women in the equal-access Military Health System.
We accessed MilCanEpi, which links data from the Department of Defense Central Cancer Registry and Military Health System Data Repository administrative claims data, to identify a cohort of women aged 18-79 years who were diagnosed with uterine, cervical, or ovarian cancer between January 1, 1998, and December 31, 2014. Information on tumor stage, grade, and histology was used to determine which treatment(s) (surgery, chemotherapy, radiotherapy) was indicated for each patient according to the National Comprehensive Cancer Network Guidelines during the period of the data (1998-2014). We compared non-Hispanic Black, Asian, and Hispanic women with non-Hispanic White women in their likelihood to receive guideline-adherent treatment using multivariable logistic regression models given as adjusted odds ratios (aORs) and 95% CIs.
The study included 3,354 women diagnosed with a gynecologic cancer of whom 68.7% were non-Hispanic White, 15.6% Asian, 9.0% non-Hispanic Black, and 6.7% Hispanic. Overall, 77.8% of patients received guideline-adherent treatment (79.1% non-Hispanic White, 75.9% Asian, 69.3% non-Hispanic Black, and 80.5% Hispanic). Guideline-adherent treatment was similar in Asian compared with non-Hispanic White patients (aOR 1.18, 95% CI 0.84-1.48) or Hispanic compared with non-Hispanic White women (aOR 1.30, 95% CI 0.86-1.96). Non-Hispanic Black patients were marginally less likely to receive guideline-adherent treatment compared with non-Hispanic White women (aOR 0.73, 95% CI 0.53-1.00, P=.011) and significantly less likely to receive guideline-adherent treatment than either Asian (aOR 0.65, 95% CI 0.44-0.97) or Hispanic patients (aOR 0.56, 95% CI 0.34-0.92).
Racial-ethnic differences in guideline-adherent care among patients in the equal-access Military Health System suggest factors other than access to care contributed to the observed disparities.
比较非西班牙裔白人女性和少数族裔女性在享有平等机会的军事卫生系统中接受符合国家综合癌症网络指南的妇科癌症（包括子宫、宫颈和卵巢癌）治疗的情况。
我们访问了 MilCanEpi，该系统将国防部中央癌症登记处和军事卫生系统数据存储库的行政索赔数据链接起来，以确定 1998 年 1 月 1 日至 2014 年 12 月 31 日期间年龄在 18-79 岁之间被诊断患有子宫、宫颈或卵巢癌的女性队列。根据国家综合癌症网络指南（1998-2014 年期间），使用肿瘤分期、分级和组织学信息确定每位患者应接受哪种（种）治疗（手术、化疗、放疗）。我们使用多变量逻辑回归模型比较了非西班牙裔黑人、亚洲人和西班牙裔女性与非西班牙裔白人女性在接受符合指南的治疗方面的可能性，并给出了调整后的优势比（aOR）和 95%置信区间（CI）。
该研究包括 3354 名被诊断患有妇科癌症的女性，其中 68.7%是非西班牙裔白人，15.6%是亚洲人，9.0%是非西班牙裔黑人，6.7%是西班牙裔。总体而言，77.8%的患者接受了符合指南的治疗（79.1%是非西班牙裔白人，75.9%是亚洲人，69.3%是非西班牙裔黑人，80.5%是西班牙裔）。亚洲患者与非西班牙裔白人患者（aOR 1.18，95%CI 0.84-1.48）或西班牙裔患者与非西班牙裔白人女性（aOR 1.30，95%CI 0.86-1.96）相比，接受符合指南的治疗的情况相似。与非西班牙裔白人女性相比，非西班牙裔黑人患者接受符合指南的治疗的可能性略低（aOR 0.73，95%CI 0.53-1.00，P=.011），并且与亚洲患者（aOR 0.65，95%CI 0.44-0.97）或西班牙裔患者（aOR 0.56，95%CI 0.34-0.92）相比，接受符合指南的治疗的可能性明显更低。
在享有平等机会的军事卫生系统中，患者之间在符合指南的治疗方面存在种族差异，这表明除了获得医疗保健的机会之外，还有其他因素导致了观察到的差异。
