Section of Cancer Economics and Policy, Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA.
J Natl Cancer Inst. 2023 Mar 9;115(3):295-302. doi: 10.1093/jnci/djac203.
There is a lack of evidence from nationwide samples on the disparity of initiating immune checkpoint inhibitors (ICIs) after metastatic lung cancer diagnosis.
We identified metastatic lung cancer patients diagnosed between 2015 and 2020 from a large, nationwide commercial claims database. We analyzed the time from metastatic lung cancer diagnosis to ICI therapy using Cox proportional hazard models. Independent variables included county-level measures (quintiles of percentage of racialized population, quintiles of percentage of population below poverty, urbanity, and density of medical oncologists) and patient characteristics (age, sex, Charlson comorbidity index, Medicare Advantage, and year of diagnosis). All tests were 2-sided.
A total of 17 022 patients were included. Counties with a larger proportion of racialized population appeared to be more urban, have a greater percentage of its residents in poverty, and have a higher density of medical oncologists. In Cox analysis, the adjusted hazard ratio of the second, third, fourth, and highest quintile of percentage of racialized population were 0.89 (95% confidence interval [CI] = 0.82 to 0.98), 0.85 (95% CI = 0.78 to 0.93), 0.78 (95% CI = 0.71 to 0.86), and 0.71 (95% CI = 0.62 to 0.81), respectively, compared with counties in the lowest quintile. The slower ICI therapy initiation was driven by counties with the highest percentage of Hispanic population and other non-Black racialized groups.
Commercially insured patients with metastatic lung cancer who lived in counties with greater percentage of racialized population had slower initiation of ICI therapy after lung cancer diagnosis, despite greater density of oncologists in their neighborhood.
缺乏全国范围内样本的证据表明，转移性肺癌诊断后启动免疫检查点抑制剂（ICI）的差异。
我们从一个大型的全国性商业索赔数据库中确定了 2015 年至 2020 年间诊断为转移性肺癌的患者。我们使用 Cox 比例风险模型分析了从转移性肺癌诊断到 ICI 治疗的时间。自变量包括县级指标（按人口中种族化人口比例的五分位数、按贫困人口比例的五分位数、城市化程度和肿瘤内科医生密度的五分位数）和患者特征（年龄、性别、Charlson 合并症指数、医疗保险优势和诊断年份）。所有检验均为双侧检验。
共纳入 17022 例患者。种族化人口比例较大的县似乎更城市化，贫困居民比例更高，肿瘤内科医生密度更高。在 Cox 分析中，种族化人口比例第二、第三、第四和最高五分位数的调整后危险比分别为 0.89（95%置信区间[CI] = 0.82 至 0.98）、0.85（95%CI = 0.78 至 0.93）、0.78（95%CI = 0.71 至 0.86）和 0.71（95%CI = 0.62 至 0.81），与最低五分位数的县相比。具有最高西班牙裔人口比例和其他非黑人种族化群体的县，ICI 治疗的启动速度较慢。
尽管社区肿瘤医生密度较高，但与居住在种族化人口比例较高的县的转移性肺癌商业保险患者相比，他们在肺癌诊断后接受 ICI 治疗的启动速度较慢。
