不同族裔的黑人群体之间，早期非小细胞肺癌患者接受以治愈为目的治疗的种族/民族差异：美国出生的黑人、非裔海地人、西印度群岛黑人以及西班牙裔黑人。
Racial/ethnic disparities in curative-intent treatment for early-stage non-small cell lung cancer patients among heterogeneous Black populations: US-born Black, Afro-Haitian, West Indian Black, and Hispanic Black.
机构信息
College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, Tallahassee, Florida, USA.
Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida, USA.
出版信息
Cancer Med. 2024 Oct;13(19):e7449. doi: 10.1002/cam4.7449.
BACKGROUND
Heterogeneous Black populations encounter significant obstacles in accessing cancer care, yet research on lung cancer treatment disparities remains limited. This study investigates whether the disparity in receiving curative-intent treatment (curative-intent surgery and/or stereotactic body radiation therapy [SBRT]) for early-stage non-small cell lung cancer (NSCLC) between non-Hispanic Whites (NHWs) and total Blacks extends to diverse Black populations, including US-born, Afro-Haitian, West Indian Black, and Hispanic Black individuals.
METHODS
This cross-sectional study included all Florida cancer registry early-stage NSCLC cases 2005-2017, linked to individual-level discharge data containing comorbidity and specific treatment details (surgery and/or SBRT). Multivariable logistic regression assessed the association between race/ethnicity and the receipt of curative-intent treatment, while accounting for sociodemographic factors (poverty, age, insurance, and smoking status) and clinical variables.
RESULTS
Among 55,655 early-stage NSCLC patients, 71.1% received curative-intent treatment: 72.1% NHW and 59.7% Black (non-Hispanic and Hispanic) individuals. Black patients had 35% lower odds (OR, 0.65; 95% CI, 0.59-0.70) of receiving curative-intent treatment compared to NHW patients. ORs varied from 0.57 (95% CI, 0.59-0.70) for Hispanic Black to 0.76 (95% CI, 0.56-1.02) for West Indian Black. Remarkably, Black-White disparities persisted despite the availability of curative treatment options (SBRT) for both high Charlson Comorbidity Index (CCI) observed among US-born Blacks and surgery for low CCI patients among all other Black subgroups.
CONCLUSIONS
Pronounced disparities in accessing curative-intent treatments for early-stage NSCLC were evident across all Black subgroups, regardless of treatment availability and comorbidity profile. These findings underscore the need to address Black heterogeneity and prompt further research to rectify treatment disparities in early-stage NSCLC.
背景
不同族裔的黑人在获得癌症治疗方面面临着重大障碍，但关于肺癌治疗差异的研究仍然有限。本研究旨在探讨非裔美国人与非西班牙裔白人（NHW）之间在接受早期非小细胞肺癌（NSCLC）根治性治疗（根治性手术和/或立体定向体放射治疗[SBRT]）方面的差异是否也存在于多样化的黑人人群中，包括在美国出生的、来自海地的、西印度群岛的和西班牙裔的黑人。
方法
本横断面研究纳入了 2005 年至 2017 年所有佛罗里达癌症登记处的早期 NSCLC 病例，并与个体水平的出院数据相关联，该数据包含合并症和特定治疗细节（手术和/或 SBRT）。多变量逻辑回归评估了种族/族裔与接受根治性治疗之间的关联，同时考虑了社会人口统计学因素（贫困、年龄、保险和吸烟状况）和临床变量。
结果
在 55655 例早期 NSCLC 患者中，71.1%接受了根治性治疗：72.1%的 NHW 和 59.7%的黑人（非西班牙裔和西班牙裔）患者。与 NHW 患者相比，黑人患者接受根治性治疗的可能性低 35%（比值比[OR]，0.65；95%置信区间[CI]，0.59-0.70）。OR 从西班牙裔黑人的 0.57（95%CI，0.59-0.70）到西印度群岛黑人的 0.76（95%CI，0.56-1.02）不等。值得注意的是，尽管对于美国出生的黑人高 Charlson 合并症指数（CCI）和所有其他黑人亚组低 CCI 患者均提供了根治性治疗选择（SBRT），但黑人和白人之间的差异仍然存在。
结论
在所有黑人亚组中，早期 NSCLC 接受根治性治疗的明显差异仍然存在，无论治疗方法的可用性和合并症情况如何。这些发现强调了需要解决黑人的异质性，并促使进一步研究以纠正早期 NSCLC 的治疗差异。
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