预后因素分布对社会经济弱势群体癌症患者死亡率差异的影响。

Impact of prognostic factor distributions on mortality disparities for socioeconomically disadvantaged cancer patients.

机构信息

Center for Epidemiology and Healthcare Delivery Research, JPS Health Network, Fort Worth, TX.

Oncology and Infusion Center, JPS Health Network, Fort Worth, Texas; Department of Internal Medicine, TCU & UNTHSC School of Medicine, Fort Worth, Texas.

出版信息

Ann Epidemiol. 2022 Jan;65:31-37. doi: 10.1016/j.annepidem.2021.09.014. Epub 2021 Oct 1.

DOI:10.1016/j.annepidem.2021.09.014

PMID:34601096

Abstract

PURPOSE

We aimed to assess whether differences in the distributions of prognostic factors explain reported mortality disparities between urban safety-net and Surveillance, Epidemiology, and End Results (SEER) cancer populations.

METHODS

We used data from SEER and a safety-net cancer center in Texas. Eligible patients were adults aged ≤64 years and diagnosed with first primary female breast, colorectal, or lung cancer between 2008 and 2016. We estimated crude and adjusted risk differences (RD) in 3- and 5-year all-cause mortality (1- and 3-year for lung cancer), where adjustment was based on entropy balancing weights that standardized the distribution of sociodemographic and tumor characteristics between the two populations.

RESULTS

Our study populations comprised 1914 safety-net patients and 389,709 SEER patients. For breast cancer, the crude 3- and 5-year mortality RDs between safety-net and SEER populations were 7.7% (95% confidence limits [CL]: 4.3%, 11%) and 11% (95% CL: 6.7%, 16%). Adjustment for measured prognostic factors reduced the mortality RDs (3-year adjusted RD = 0.049%, 95% CL: -2.6%, 2.6%; 5-year adjusted RD = 5.6%, 95% CL: -0.83%, 12%). We observed similar patterns for colorectal and lung cancer albeit less magnitude.

CONCLUSIONS

Sociodemographic and tumor characteristics may largely explain early mortality disparities between safety-net and SEER populations but not late mortality disparities.

摘要

目的

我们旨在评估预后因素分布的差异是否可以解释城市医疗救助机构和监测、流行病学和最终结果（SEER）癌症人群之间报告的死亡率差异。

方法

我们使用了来自 SEER 和德克萨斯州一家医疗救助癌症中心的数据。合格的患者为年龄≤64 岁且在 2008 年至 2016 年间被诊断为第一原发性女性乳腺癌、结直肠癌或肺癌的成年人。我们估计了 3 年和 5 年全因死亡率（1 年和 3 年用于肺癌）的粗死亡率差异（RD）和调整后的死亡率差异（RD），调整是基于熵平衡权重，该权重标准化了两个人群之间的社会人口统计学和肿瘤特征的分布。

结果

我们的研究人群包括 1914 名医疗救助患者和 389709 名 SEER 患者。对于乳腺癌，医疗救助和 SEER 人群的 3 年和 5 年粗死亡率 RD 分别为 7.7%（95%置信区间[CL]：4.3%，11%）和 11%（95% CL：6.7%，16%）。调整测量的预后因素降低了死亡率 RD（3 年调整 RD=0.049%，95% CL：-2.6%，2.6%；5 年调整 RD=5.6%，95% CL：-0.83%，12%）。我们观察到结直肠癌和肺癌也存在类似的模式，尽管幅度较小。