Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ 85711, USA.
Department of Urology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA.
Int J Environ Res Public Health. 2022 Jan 21;19(3):1185. doi: 10.3390/ijerph19031185.
American Indians/Alaska Natives (AI/AN) and Hispanic Americans (HA) have higher kidney cancer incidence and mortality rates compared to non-Hispanic Whites (NHW). Herein, we describe the disparity in renal cell carcinoma (RCC) surgical treatment for AI/AN and HA and the potential association with mortality in Arizona. A total of 5111 stage I RCC cases diagnosed between 2007 and 2016 from the Arizona Cancer Registry were included. Statistical analyses were performed to test the association of race/ethnicity with surgical treatment pattern and overall mortality, adjusting for patients' demographic, healthcare access, and socioeconomic factors. AI/AN were diagnosed 6 years younger than NHW and were more likely to receive radical rather than partial nephrectomy (OR 1.49 95% CI: 1.07-2.07) compared to NHW. Mexican Americans had increased odds of not undergoing surgical treatment (OR 1.66, 95% CI: 1.08-2.53). Analysis showed that not undergoing surgical treatment and undergoing radical nephrectomy were statistically significantly associated with higher overall mortality (HR 1.82 95% CI: 1.21-2.76 and HR 1.59 95% CI: 1.30-1.95 respectively). Mexican Americans, particularly U.S.-born Mexican Americans, had an increased risk for overall mortality and RCC-specific mortality even after adjusting for neighborhood socioeconomic factors and surgical treatment patterns. Although statistically not significant after adjusting for neighborhood-level socioeconomic factors and surgical treatment patterns, AI/AN had an elevated risk of mortality.
美国印第安人/阿拉斯加原住民(AI/AN)和西班牙裔美国人(HA)的肾癌发病率和死亡率高于非西班牙裔白人(NHW)。在此,我们描述了亚利桑那州 AI/AN 和 HA 人群肾细胞癌(RCC)手术治疗的差异,并探讨了其与死亡率的潜在关联。从亚利桑那州癌症登记处纳入了 2007 年至 2016 年间诊断的共 5111 例 I 期 RCC 病例。进行了统计学分析,以检验种族/民族与手术治疗模式和总死亡率之间的关联,同时调整了患者的人口统计学、医疗保健可及性和社会经济因素。与 NHW 相比,AI/AN 被诊断出的年龄要小 6 岁,更有可能接受根治性而不是部分肾切除术(OR 1.49,95%CI:1.07-2.07)。与 NHW 相比,墨西哥裔美国人接受手术治疗的可能性较小(OR 1.66,95%CI:1.08-2.53)。分析表明,未接受手术治疗和接受根治性肾切除术与总死亡率升高具有统计学显著相关性(HR 1.82,95%CI:1.21-2.76 和 HR 1.59,95%CI:1.30-1.95)。即使在调整了邻里社会经济因素和手术治疗模式后,墨西哥裔美国人,尤其是美国出生的墨西哥裔美国人,其总死亡率和 RCC 特异性死亡率的风险仍然增加。尽管在调整了邻里社会经济因素和手术治疗模式后,AI/AN 的死亡率没有统计学意义,但仍存在升高的风险。