Wieder Robert, Adam Nabil
Rutgers New Jersey Medical School and the Cancer Institute of New Jersey, 185 South Orange Avenue, MSB F671, Newark, NJ 07103, USA.
Phalcon, LLC, Manhasset, NY 11030, USA.
Cancers (Basel). 2023 Aug 30;15(17):4333. doi: 10.3390/cancers15174333.
Despite lower incidence rates, African American (AA) patients have shorter survival from breast cancer (BC) than white (W) patients. Multiple factors contribute to decreased survival, including screening disparities, later presentation, and access to care. Disparities in adverse events (AEs) may contribute to delayed or incomplete treatment, earlier recurrence, and shortened survival. Here, we analyzed the SEER-Medicare dataset, which captures claims from a variety of venues, in order to determine whether the cancer care venues affect treatment and associated adverse events. We investigated a study population whose claims are included in the Outpatient files, consisting of hospital and healthcare facility venues, and a study population from the National Claims History (NCH) files, consisting of claims from physicians, office practices, and other non-institutional providers. We demonstrated statistically and substantively significant venue-specific differences in treatment rates, drugs administered, and AEs from treatments between AA and W patients. We showed that AA patients in the NCH dataset received lower rates of treatment, but patients in the Outpatient dataset received higher rates of treatment than W patients. The rates of recorded AEs per treatment were higher in the NCH setting than in the Outpatient setting in all patients. AEs were consistently higher in AA patients than in W patients. AA patients had higher comorbidity indices and were younger than W patients, but these variables did not appear to play roles in the AE differences. The frequency of specific anticancer drugs administered in cancer- and venue-specific circumstances and their associated AEs varied between AA and W patients. The higher AE rates were due to slightly higher frequencies in the administration of drugs with higher associated AE rates in AA patients than in W patients. Our investigations demonstrate significant differences in treatment rates and associated AEs between AA and W patients with BC, depending on the venues of care, likely contributing to differences in outcomes.
尽管发病率较低，但非裔美国（AA）乳腺癌（BC）患者的生存期比白人（W）患者短。多种因素导致生存期缩短，包括筛查差异、就诊较晚以及获得治疗的机会。不良事件（AE）的差异可能导致治疗延迟或不完整、复发较早以及生存期缩短。在此，我们分析了监测、流行病学与最终结果（SEER）医保数据集，该数据集收集了来自各种场所的理赔数据，以确定癌症治疗场所是否会影响治疗及相关不良事件。我们调查了一个研究人群，其理赔数据包含在门诊文件中，该文件由医院和医疗机构场所组成，以及一个来自国家理赔历史（NCH）文件的研究人群，该文件包含来自医生、门诊诊所和其他非机构提供者的理赔数据。我们证明了AA和W患者在治疗率、所用药物以及治疗相关不良事件方面存在统计学上和实质上显著的场所特异性差异。我们发现，NCH数据集中的AA患者接受治疗的比例较低，但门诊数据集中的患者比W患者接受治疗的比例更高。在所有患者中，NCH环境下每次治疗记录的AE发生率高于门诊环境。AA患者的AE发生率始终高于W患者。AA患者的合并症指数较高且比W患者年轻，但这些变量似乎并未在AE差异中起作用。在癌症和场所特定情况下使用的特定抗癌药物的频率及其相关AE在AA和W患者之间有所不同。较高的AE发生率是由于AA患者中与较高AE发生率相关的药物给药频率略高于W患者。我们的调查表明，AA和W乳腺癌患者在治疗率和相关AE方面存在显著差异，这取决于护理场所，这可能导致了结果的差异。
