Yang Mike Z, Liu Raymond, Von Behren Julie, Lin Katherine, Adams Alyce S, Kushi Lawrence H, Quesenberry Charles P, Velotta Jeffrey B, Wong Melisa L, Young-Wolff Kelly C, Gomez Scarlett L, Shariff-Marco Salma, Sakoda Lori C
Internal Medicine Residency, Kaiser Permanente Northern California, San Francisco, CA, USA.
Department of Medical Oncology, Kaiser Permanente Northern California, San Francisco, CA, USA.
Perm J. 2024 Sep 16;28(3):13-22. doi: 10.7812/TPP/24.028. Epub 2024 Jun 12.
Observational research is important for understanding the real-world benefits of advancements in lung cancer care. Integrated health care systems, such as Kaiser Permanente Northern California, have extensive electronic health records suitable for such research, but the generalizability of their populations is often questioned.
Leveraging data from the California Cancer Registry, the authors compared distributions of demographic and clinical characteristics, in addition to neighborhood and environmental conditions, between patients diagnosed with lung cancer from 2015 through 2019 at Kaiser Permanente Northern California, National Cancer Institute-designated cancer centers (NCICCs), and all other non-NCICC hospitals within the same catchment area.
Of 20,178 included patients, 30% were from Kaiser Permanente Northern California, 8% from NCICCs, and 62% from other non-NCICC hospitals. Compared to NCICC patients, Kaiser Permanente Northern California patients were more similar to other non-NCICC patients on most characteristics. Compared to other non-NCICC patients, Kaiser Permanente Northern California patients were slightly older, more likely to be female, and less likely to be Hispanic or Asian/Pacific Islander and to reside in lower socioeconomic status (SES) neighborhoods. In contrast, NCICC patients were younger, less likely to be female or from non-Asian/Pacific Islander minoritized racial groups, and more likely to present with early-stage disease and adenocarcinoma and to reside in neighborhoods with higher SES and lower air pollution than Kaiser Permanente Northern California or other non-NCICC patients.
Patients from Kaiser Permanente Northern California, compared to NCICCs, are more broadly representative of the underlying patient population with lung cancer.
Research using electronic health record data from integrated health care systems can contribute generalizable real-world evidence to benchmark and improve lung cancer care.
观察性研究对于了解肺癌治疗进展的实际益处非常重要。像北加利福尼亚凯撒医疗集团这样的综合医疗保健系统拥有适用于此类研究的广泛电子健康记录，但其人群的普遍性常常受到质疑。
作者利用加利福尼亚癌症登记处的数据，比较了2015年至2019年在北加利福尼亚凯撒医疗集团、美国国立癌症研究所指定的癌症中心（NCICC）以及同一集水区内所有其他非NCICC医院被诊断为肺癌的患者之间的人口统计学和临床特征分布，以及社区和环境状况。
在纳入的20178名患者中，30%来自北加利福尼亚凯撒医疗集团，8%来自NCICC，62%来自其他非NCICC医院。与NCICC患者相比，北加利福尼亚凯撒医疗集团的患者在大多数特征上与其他非NCICC患者更相似。与其他非NCICC患者相比，北加利福尼亚凯撒医疗集团的患者年龄稍大，女性比例更高，西班牙裔或亚裔/太平洋岛民比例更低，居住在社会经济地位较低（SES）社区的可能性更小。相比之下，NCICC患者更年轻，女性或来自非亚裔/太平洋岛民少数族裔的可能性更小，更有可能表现为早期疾病和腺癌，并且居住在社会经济地位较高、空气污染低于北加利福尼亚凯撒医疗集团或其他非NCICC患者的社区。
与NCICC相比，北加利福尼亚凯撒医疗集团的患者更广泛地代表了肺癌潜在患者群体。
使用综合医疗保健系统电子健康记录数据的研究可以提供可推广的真实世界证据，以规范和改善肺癌治疗。
