Section of Epidemiology and Population Science, Baylor College of Medicine, Houston, Texas, USA.
Institute for Clinical & Translational Research, Baylor College of Medicine, Houston, Texas, USA.
Am J Hematol. 2022 Aug;97(8):1044-1054. doi: 10.1002/ajh.26623. Epub 2022 Jun 17.
The epidemiology of cancer-associated thrombosis (CAT) among uninsured and vulnerable populations in the US is not well-characterized. We performed a retrospective cohort study for patients with newly diagnosed cancer from 2011 to 2020 at Harris Health System, which cares for uninsured residents in the Houston metropolitan area. Patient demographics, NCI comorbidity index, area of deprivation index (ADI), cancer histology, staging, and systemic therapy data were extracted. CAT included overall venous thromboembolism (VTE) or pulmonary embolism +/- lower extremity deep vein thrombosis (PE/LE-DVT) within 1 year of diagnosis. We used multivariable Fine-Gray models to assess the associations with CAT accounting for death as a competing risk. Among 15 342 patients, 74% were uninsured and 84% lived in socioeconomically disadvantaged neighborhoods. There were 16% Non-Hispanic White (NHW), 28% Non-Hispanic Black (NHB), 50% Hispanic (27% Mexican), and 6% Asian/Pacific Islanders (API). The 1-year CAT incidence rate was 14.6%. Overall VTE was lower for Hispanics versus NHW (SHR 0.87 [0.76-0.99]) and API versus NHW (SHR 0.58 [0.44-0.77]). PE/LE-DVT was higher for NHB versus NHW (SHR 1.18 [1.01-1.39]). CAT was also associated with chemotherapy-based regimens (+/- immunotherapy), age, obesity, cancer type/staging, VTE history, and recent hospitalization. NCI comorbidity and ADI scores were associated with mortality but not CAT. In a large cohort of underserved patients with cancer, we identified an elevated incidence of CAT with known and novel risk predictors. Hispanics had lower adjusted rates of CAT and mortality. Our findings highlight the need to investigate and incorporate vulnerable populations in clinical trials.
美国无保险和弱势人群癌症相关血栓形成 (CAT) 的流行病学情况尚不清楚。我们对 2011 年至 2020 年期间在哈里斯卫生系统 (Harris Health System) 新诊断出癌症的患者进行了回顾性队列研究，该系统为休斯顿大都市区的无保险居民提供服务。提取了患者人口统计学、NCI 合并症指数、贫困地区指数 (ADI)、癌症组织学、分期和全身治疗数据。CAT 包括诊断后 1 年内的总静脉血栓栓塞症 (VTE) 或肺栓塞 +/-下肢深静脉血栓形成 (PE/LE-DVT)。我们使用多变量 Fine-Gray 模型评估 CAT 的关联，同时考虑死亡作为竞争风险。在 15342 名患者中，74%没有保险，84%居住在社会经济劣势社区。非西班牙裔白人 (NHW) 占 16%，非西班牙裔黑人 (NHB) 占 28%，西班牙裔占 50%（其中 27%为墨西哥裔），亚裔/太平洋岛民 (API) 占 6%。1 年 CAT 发生率为 14.6%。与 NHW 相比，西班牙裔的总体 VTE 较低 (SHR 0.87 [0.76-0.99])，与 API 相比，西班牙裔的 VTE 较低 (SHR 0.58 [0.44-0.77])。与 NHW 相比，NHB 的 PE/LE-DVT 更高 (SHR 1.18 [1.01-1.39])。CAT 还与基于化疗的方案（+/-免疫疗法）、年龄、肥胖、癌症类型/分期、VTE 病史和最近住院有关。NCI 合并症和 ADI 评分与死亡率相关，但与 CAT 无关。在一个大型癌症服务不足患者队列中，我们发现了一种发病率较高的 CAT，其具有已知和新的风险预测因子。与 NHW 相比，西班牙裔的 CAT 和死亡率调整率较低。我们的研究结果强调了在临床试验中需要调查和纳入弱势群体的必要性。
