Taylor Zachariah, Kjelstrom Stephanie, Buckley Meghan, Cahn David
Urology, Main Line Health, Philadelphia, USA.
Statistics, Lankenau Institute for Medical Research, Wynnewood, USA.
Cureus. 2023 Sep 21;15(9):e45723. doi: 10.7759/cureus.45723. eCollection 2023 Sep.
Objectives Our objectives were to (1) determine the association between ethnicity and high-risk prostate cancer (PCa) survival and (2) determine whether this association is modified by insurance status. Methods We performed a retrospective review of the National Cancer Database (NCDB) from 2004 to 2017 of non-Hispanic White (NHW), Hispanic White (HW), or Black men with high-risk PCa. A multivariate Cox regression model was built to test the association between overall survival (OS) and race/ethnicity, insurance status, and their interaction, controlling for various socioeconomic and disease-specific variables. Results A total of 94,708 men with high-risk PCa were included in the analysis. Both HW and Black men had lower socioeconomic status characteristics and lower rates of private insurance. Race/ethnicity was significantly associated with OS in the adjusted analysis. Only Medicare demonstrated significantly worse OS. NHW (covariate-adjusted hazard ratio (aHR): 1.83, 95% CI: 1.45-2.32) and Black (aHR: 1.71, 05% CI: 1.34-2.19) men demonstrated significantly worse survival when compared to HW men. Subgroup analysis demonstrated significant differences occurring among HW men with private insurance/managed care when compared to those not insured, Medicaid, Medicare, and other government insurance types. Conclusion Despite socioeconomic and demographic disadvantages, HW men demonstrate improved OS compared to NHW men. Furthermore, HW men demonstrated improved OS compared to NHW men within nearly each insurance status type. This finding is likely the result of a complex multifactorial web and as such serves as an interesting hypothesis-generating study.
目的 我们的目的是：（1）确定种族与高危前列腺癌（PCa）生存率之间的关联；（2）确定这种关联是否会因保险状况而改变。方法 我们对2004年至2017年国家癌症数据库（NCDB）中患有高危PCa的非西班牙裔白人（NHW）、西班牙裔白人（HW）或黑人男性进行了回顾性研究。构建了一个多变量Cox回归模型，以检验总生存期（OS）与种族/民族、保险状况及其相互作用之间的关联，并控制各种社会经济和疾病特异性变量。结果 共有94,708名患有高危PCa的男性纳入分析。HW和黑人男性的社会经济地位特征较低，私人保险率也较低。在调整分析中，种族/民族与OS显著相关。只有医疗保险显示出明显更差的OS。与HW男性相比，NHW（协变量调整风险比（aHR）：1.83，95%CI：1.45 - 2.32）和黑人（aHR：1.71，95%CI：1.34 - 2.19）男性的生存率明显更差。亚组分析表明，与未参保、医疗补助、医疗保险和其他政府保险类型的HW男性相比，有私人保险/管理式医疗的HW男性之间存在显著差异。结论 尽管存在社会经济和人口统计学方面的劣势，但与NHW男性相比，HW男性的OS有所改善。此外，在几乎每种保险状况类型中，HW男性的OS都比NHW男性有所改善。这一发现可能是一个复杂的多因素网络的结果，因此是一项有趣的产生假设的研究。
