Wang Fei, Shu Xiang, Pal Tuya, Berlin Jordan, Nguyen Sang M, Zheng Wei, Bailey Christina E, Shu Xiao-Ou
Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA.
Department of Breast Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, China.
Cancers (Basel). 2022 Jul 12;14(14):3390. doi: 10.3390/cancers14143390.
The reasons underlying racial/ethnic mortality disparities for cancer patients remain poorly understood, especially regarding the role of access to care. Over five million patients with a primary diagnosis of lung, breast, prostate, colon/rectum, pancreas, ovary, or liver cancer during 2004-2014, were identified from the National Cancer Database. Cox proportional hazards models were applied to estimate hazard ratios (HR) and 95% confidence intervals (CI) for total mortality associated with race/ethnicity, and access to care related factors (i.e., socioeconomic status [SES], insurance, treating facility, and residential type) for each cancer. Racial/ethnic disparities in total mortality were observed across seven cancers. Compared with non-Hispanic (NH)-white patients, NH-black patients with breast (HR = 1.27, 95% CI: 1.26 to 1.29), ovarian (HR = 1.20, 95% CI: 1.17 to 1.23), prostate (HR = 1.31, 95% CI: 1.30 to 1.33), colorectal (HR = 1.11, 95% CI: 1.10 to 1.12) or pancreatic (HR = 1.03, 95% CI: 1.02 to 1.05) cancers had significantly elevated mortality, while Asians (13-31%) and Hispanics (13-19%) had lower mortality for all cancers. Racial/ethnic disparities were observed across all strata of access to care related factors and modified by those factors. NH-black and NH-white disparities were most evident among patients with high SES or those with private insurance, while Hispanic/Asian versus NH-white disparities were more evident among patients with low SES or those with no/poor insurance. Racial/ethnic mortality disparities for major cancers exist across all patient groups with different access to care levels. The influence of SES or insurance on mortality disparity follows different patterns for racial/ethnic minorities versus NH-whites. Our study highlights the need for racial/ethnic-specific strategies to reduce the mortality disparities for major cancers.
癌症患者种族/族裔死亡率差异背后的原因仍鲜为人知，尤其是在获得医疗服务的作用方面。从国家癌症数据库中识别出2004年至2014年期间初次诊断为肺癌、乳腺癌、前列腺癌、结肠/直肠癌、胰腺癌、卵巢癌或肝癌的500多万患者。应用Cox比例风险模型来估计与种族/族裔以及每种癌症的医疗服务相关因素（即社会经济地位[SES]、保险、治疗机构和居住类型）相关的总死亡率的风险比（HR）和95%置信区间（CI）。在七种癌症中均观察到了总死亡率的种族/族裔差异。与非西班牙裔（NH）白人患者相比，患有乳腺癌（HR = 1.27，95% CI：1.26至1.29）、卵巢癌（HR = 1.20，95% CI：1.17至1.23）、前列腺癌（HR = 1.31，95% CI：1.30至1.33）、结肠直肠癌（HR = 1.11，95% CI：1.10至1.12）或胰腺癌（HR = 1.03，95% CI：1.02至1.05）的NH黑人患者死亡率显著升高，而亚洲人（13 - 31%）和西班牙裔（13 - 19%）在所有癌症中的死亡率较低。在医疗服务相关因素的所有分层中均观察到了种族/族裔差异，并且这些差异会受到这些因素的影响。NH黑人和NH白人之间的差异在高SES患者或有私人保险的患者中最为明显，而西班牙裔/亚洲人与NH白人之间的差异在低SES患者或无保险/保险较差的患者中更为明显。在所有不同医疗服务可及水平的患者群体中，主要癌症的种族/族裔死亡率差异均存在。SES或保险对死亡率差异的影响在少数族裔与NH白人之间呈现出不同的模式。我们的研究强调了需要制定针对种族/族裔的策略来减少主要癌症的死亡率差异。
