慢性病对癌症患者 COVID-19 相关住院的种族差异的影响。
Effect of chronic disease on racial difference in COVID-19-associated hospitalization among cancer patients.
机构信息
Louisiana Tumor Registry, Epidemiology Program, School of Public Health, Louisiana State University (LSU) Health, New Orleans, LA, USA.
Biostatistics Program, School of Public Health, LSU Health, New Orleans, LA, USA.
出版信息
J Natl Cancer Inst. 2023 Oct 9;115(10):1204-1212. doi: 10.1093/jnci/djad150.
BACKGROUND
Research indicates that Black cancer patients have higher rates of COVID-19 hospitalization than their White counterparts. However, the extent to which chronic diseases contribute to racial disparities remains uncertain. We aimed to quantify the effect of chronic diseases on racial disparity in COVID-19-associated hospitalization among cancer patients.
METHODS
We linked Louisiana Tumor Registry's data with statewide COVID-19 data and hospital in-patient discharge data to identify patients diagnosed with cancer in 2015-2019 who tested positive for COVID-19 in 2020 and those with COVID-19-associated hospitalization. Multivariable logistic regression and mediation methods based on linear structural equations were employed to assess the effects of the number of chronic diseases (0, 1-2, ≥3) and individual chronic diseases.
RESULTS
Of 6381 cancer patients who tested positive for COVID-19, 31.6% were non-Hispanic Black cancer patients. Compared with non-Hispanic White cancer patients, non-Hispanic Black cancer patients had a higher prevalence of chronic diseases (79.5% vs 66.0%) and higher COVID-19-associated hospitalization (27.2% vs 17.2%). The odds of COVID-19-associated hospitalization were 80% higher for non-Hispanic Black cancer patients than non-Hispanic White cancer patients (odds ratio = 1.80, 95% confidence interval = 1.59 to 2.04). After adjusting for age, sex, insurance, poverty, obesity, and cancer type, number of chronic diseases explained 37.8% of the racial disparity in COVID-19-associated hospitalization, and hypertension, diabetes, and chronic renal disease were the top 3 chronic diseases explaining 9.6%, 8.9%, and 7.3% of the racial disparity, respectively.
CONCLUSION
Chronic diseases played a substantial role in the racial disparity in COVID-19-associated hospitalization among cancer patients, especially hypertension, diabetes, and renal disease. Understanding and addressing the root causes are crucial for targeted interventions, policies, and health-care strategies to reduce racial disparity.
背景
研究表明，黑人癌症患者 COVID-19 住院率高于白人癌症患者。然而，慢性疾病在多大程度上导致了种族差异仍不确定。我们旨在量化慢性疾病对癌症患者 COVID-19 相关住院率的种族差异的影响。
方法
我们将路易斯安那州肿瘤登记处的数据与全州 COVID-19 数据和医院住院患者出院数据相链接，以确定 2015 年至 2019 年期间被诊断患有癌症且在 2020 年 COVID-19 检测呈阳性的患者，以及患有 COVID-19 相关住院的患者。我们采用多变量逻辑回归和基于线性结构方程的中介方法来评估慢性疾病数量（0、1-2、≥3）和个体慢性疾病的影响。
结果
在 6381 名 COVID-19 检测呈阳性的癌症患者中，31.6%是非西班牙裔黑人癌症患者。与非西班牙裔白人癌症患者相比，非西班牙裔黑人癌症患者的慢性疾病患病率更高（79.5% vs. 66.0%），COVID-19 相关住院率也更高（27.2% vs. 17.2%）。非西班牙裔黑人癌症患者 COVID-19 相关住院的几率是非西班牙裔白人癌症患者的 80%（比值比=1.80，95%置信区间=1.59-2.04）。在调整年龄、性别、保险、贫困、肥胖和癌症类型后，慢性疾病数量解释了 COVID-19 相关住院的种族差异的 37.8%，高血压、糖尿病和慢性肾病是导致种族差异的前 3 大慢性疾病，分别解释了 9.6%、8.9%和 7.3%的种族差异。
结论
慢性疾病在癌症患者 COVID-19 相关住院的种族差异中起着重要作用，尤其是高血压、糖尿病和肾病。了解和解决根本原因对于针对干预措施、政策和医疗保健策略以减少种族差异至关重要。
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