Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa.
State Health Registry of Iowa, College of Public Health, University of Iowa, Iowa City, Iowa.
Cancer Epidemiol Biomarkers Prev. 2023 Mar 6;32(3):398-405. doi: 10.1158/1055-9965.EPI-22-1059.
Different survival metrics have different applicability to clinical practice and research. We evaluated how choice of survival metric influences assessment of cancer survival among American Indian and Alaska Native (AIAN) people relative to non-Hispanic Whites (NHW). A secondary objective was to present variations in survival among AIAN people by age, sex, stage, and Indian Health Service (IHS) region.
Five-year survival was calculated using the North American Association of Central Cancer Registries Cancer in North America dataset. We calculated survival among AIAN people, compared with NHW using four approaches: (i) observed (crude) survival, (ii) cause-specific survival, (iii) relative survival using age- and sex-adjusted lifetables, and (iv) relative survival using lifetables additionally adjusted for race, geography, and socioeconomic status. For AIAN people, we evaluated how survival varied by age, stage at diagnosis, and IHS region.
Observed survival methods produced the lowest estimates, and-excepting prostate cancer-cause-specific methods produced the highest survival estimates. Survival was lower among AIAN people than NHW for all methods. Among AIAN people, survival was higher among those 20-64 years, females, and tumors diagnosed at local stage. Survival varied by IHS region and cancer sites.
These results support the assertion that using the same methodology to compare survival estimates between racial and ethnic groups is of paramount importance, but that the choice of metric requires careful consideration of study objectives.
These findings have the potential to impact choice of survival metric to explore disparities among AIAN people.
不同的生存指标在临床实践和研究中具有不同的适用性。我们评估了在评估美国印第安人和阿拉斯加原住民（AIAN）与非西班牙裔白人（NHW）之间的癌症生存情况时，选择生存指标会如何影响评估结果。次要目标是按年龄、性别、分期和印第安卫生服务（IHS）区域展示 AIAN 人群的生存差异。
使用北美癌症登记协会癌症在北美的数据集计算 5 年生存率。我们计算了 AIAN 人群的生存情况，并与 NHW 进行了比较，使用了四种方法：（i）观察（粗）生存率，（ii）病因特异性生存率，（iii）使用年龄和性别调整的生命表计算的相对生存率，以及（iv）使用额外调整种族、地理和社会经济状况的生命表计算的相对生存率。对于 AIAN 人群，我们评估了生存情况如何随年龄、诊断时的分期以及 IHS 区域而变化。
观察性生存方法产生的估计值最低，除前列腺癌外，病因特异性方法产生的生存估计值最高。所有方法都显示 AIAN 人群的生存率低于 NHW。在 AIAN 人群中，20-64 岁、女性和局部分期诊断的肿瘤患者的生存率更高。生存情况因 IHS 区域和癌症部位而异。
这些结果支持这样的说法，即使用相同的方法来比较不同种族和族裔群体的生存估计值非常重要，但选择指标需要仔细考虑研究目标。
这些发现有可能影响选择生存指标来探索 AIAN 人群中的差异。
