Gurney Jason, Davies Anna, Stanley James, Signal Virginia, Costello Shaun, Dawkins Paul, Henare Kimiora, Jackson Chris, Lawrenson Ross, Whitehead Jesse, Koea Jonathan
Department of Public Health, University of Otago, Wellington, New Zealand.
Department of Public Health, University of Otago, Wellington, New Zealand.
Lung Cancer. 2023 May;179:107174. doi: 10.1016/j.lungcan.2023.03.010. Epub 2023 Mar 18.
A recent multinational investigation of emergency presentation within 30 days of cancer diagnosis, conducted within the International Cancer Benchmarking Programme (ICBP), observed that New Zealand had the highest rate of emergency presentation prior to lung cancer diagnosis compared to other similar countries. Here we use national-level health data to further investigate these trends, focussing on ethnic disparities in emergency presentation prior to lung cancer diagnosis. We have also compared survival outcomes between those who had an emergency presentation in the preceding 30 days to those who did not.
Our study included all lung cancer registrations between 2007 and 2019 on the New Zealand Cancer Registry (N = 27,869), linked to national hospitalisation and primary healthcare data. We used descriptive (crude and age-standardised proportions) and logistic regression (crude and adjusted odds ratios) analyses to examine primary care access prior to cancer diagnosis, emergency hospitalisation up to and including 30 days prior to diagnosis, and one-year mortality post-diagnosis, both for the total population and between ethnicities. Regression models adjusted for age, sex, deprivation, rurality, comorbidity, tumour type and stage.
We found stark disparities by ethnic group, with 62% of Pacific peoples and 54% of Māori having an emergency presentation within 30 days prior to diagnosis, compared to 47% of Europeans. These disparities remained after adjusting for multiple covariates including comorbidity and deprivation (adj. OR: Māori 1.21, 95% CI 1.13-1.30; Pacific 1.50, 95% CI 1.31-1.71). Emergency presentation was associated with substantially poorer survival outcomes across ethnic groups (e.g. 1-year mortality for Māori: no emergency presentation 50%, emergency presentation 79%; adj. OR 2.40, 95% CI 2.10-2.74).
These observations reinforce the need for improvements in the early detection of lung cancer, particularly for Māori and Pacific populations, with a view to preventing diagnosis of these cancers in an emergency setting.
在国际癌症基准项目（ICBP）开展的一项近期针对癌症诊断后30天内紧急就诊情况的跨国调查中，发现与其他类似国家相比，新西兰肺癌诊断前的紧急就诊率最高。在此，我们利用国家级健康数据进一步调查这些趋势，重点关注肺癌诊断前紧急就诊情况中的种族差异。我们还比较了在之前30天内有紧急就诊情况者与无紧急就诊情况者的生存结果。
我们的研究纳入了2007年至2019年间新西兰癌症登记处的所有肺癌登记病例（N = 27,869），并与国家住院和初级医疗保健数据相链接。我们使用描述性分析（粗率和年龄标准化比例）和逻辑回归分析（粗比值比和调整后的比值比）来研究癌症诊断前的初级医疗保健可及性、诊断前直至包括诊断前30天的紧急住院情况以及诊断后一年的死亡率，涵盖总体人群以及不同种族之间的情况。回归模型对年龄、性别、贫困程度、农村地区、合并症、肿瘤类型和分期进行了调整。
我们发现不同种族之间存在明显差异，62%的太平洋岛民和54%的毛利人在诊断前30天内有紧急就诊情况，而欧洲人这一比例为47%。在对包括合并症和贫困程度在内的多个协变量进行调整后，这些差异仍然存在（调整后的比值比：毛利人为1.21，95%置信区间为1.13 - 1.30；太平洋岛民为1.50，95%置信区间为1.31 - 1.71）。在所有种族中，紧急就诊与显著更差的生存结果相关（例如，毛利人的1年死亡率：无紧急就诊情况为50%，有紧急就诊情况为79%；调整后的比值比为2.40，95%置信区间为2.10 - 2.74）。
这些观察结果强化了改善肺癌早期检测的必要性，特别是针对毛利人和太平洋岛民人群，以期避免在紧急情况下诊断这些癌症。
