Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.
Ann Surg Oncol. 2021 Nov;28(12):7566-7574. doi: 10.1245/s10434-021-10034-w. Epub 2021 Apr 24.
While social determinants of health may adversely affect various populations, the impact of residential segregation on surgical outcomes remains poorly defined.
The objective of the current study was to examine the association between residential segregation and the likelihood to achieve a textbook outcome (TO) following cancer surgery.
The Medicare 100% Standard Analytic Files were reviewed to identify Medicare beneficiaries who underwent resection of lung, esophageal, colon, or rectal cancer between 2013 and 2017. Shannon's integration index, a measure of residential segregation, was calculated at the county level and its impact on composite TO [no complications, no prolonged length of stay (LOS), no 90-day readmission, and no 90-day mortality] was examined.
Among 200,509 patients who underwent cancer resection, the overall incidence of TO was 56.0%. The unadjusted likelihood of achieving a TO was lower among patients in low integration areas [low integration: n = 19,978 (55.0%) vs. high integration: n = 18,953 (59.3%); p < 0.001]. On multivariable analysis, patients residing in low integration areas had higher odds of complications [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.03-1.11], extended LOS (OR 1.13, 95% CI 1.09-1.18), and 90-day mortality (OR 1.29, 95% CI 1.22-1.38) and, in turn, lower odds of achieving a TO (OR 0.87, 95% CI 0.84-0.90) versus patients from highly integrated communities.
Patients who resided in counties with a lower integration index were less likely to have an optimal TO following resection of cancer compared with patients who resided in more integrated counties. The data highlight the importance of increasing residential racial diversity and integration as a means to improve patient outcomes.
尽管健康的社会决定因素可能会对各种人群产生不利影响，但居住隔离对手术结果的影响仍未得到明确界定。
本研究旨在探讨居住隔离与癌症手术后达到教科书结局（TO）的可能性之间的关联。
审查了 Medicare 100%标准分析文件，以确定在 2013 年至 2017 年间接受肺癌、食管癌、结肠癌或直肠癌切除术的 Medicare 受益人的数据。在县一级计算了 Shannon 综合指数，这是一种衡量居住隔离程度的指标，并考察了其对综合 TO（无并发症、无延长住院时间（LOS）、无 90 天再入院和无 90 天死亡率）的影响。
在 200509 名接受癌症切除术的患者中，TO 的总体发生率为 56.0%。在未调整的情况下，居住在低融合区的患者达到 TO 的可能性较低[低融合区：n=19978（55.0%）与高融合区：n=18953（59.3%）；p<0.001]。在多变量分析中，居住在低融合区的患者发生并发症的几率更高[优势比（OR）1.07，95%置信区间（CI）1.03-1.11]、延长 LOS（OR 1.13，95% CI 1.09-1.18）和 90 天死亡率（OR 1.29，95% CI 1.22-1.38），相应地，他们达到 TO 的几率更低（OR 0.87，95% CI 0.84-0.90），而那些来自高度融合社区的患者则不然。
与居住在融合程度更高的社区的患者相比，居住在县一级融合指数较低的患者在接受癌症切除术后面临更不理想的 TO 的可能性更小。这些数据强调了增加居住种族多样性和融合程度以改善患者结局的重要性。
