Martins Tanimola, Down Liz, Samuels Alfred, Lavu Deepthi, Hamilton William, Abel Gary, Neal Richard D
University of Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, Exeter.
National Institute for Health and Care Research (NIHR), Applied Research Collaboration (ARC) Southwest Peninsula (PenARC), University of Exeter, Exeter.
Br J Gen Pract. 2025 May 2;75(754):e333-e340. doi: 10.3399/BJGP.2024.0518. Print 2025 May.
UK Asian and Black patients experience longer cancer diagnostic intervals - the period between initial symptomatic presentation in primary care and cancer diagnosis.
To determine whether the differences in diagnostic intervals are because of prolonged primary care, referral, or secondary care interval.
A cohort study was undertaken of 70 971 patients with seven cancers (breast, lung, prostate, colorectal, oesophagogastric, myeloma, ovarian) diagnosed after symptom presentation in English primary care.
Data on symptom presentation and diagnosis were extracted from cancer registry-linked primary care and secondary care data. Primary interval was defined as the period between first primary care presentation and secondary care referral, referral interval as the period between referral and first secondary care appointment, and secondary care interval as the period between the first secondary care appointment and diagnosis. Accelerated failure time models were used to investigate ethnic differences across all four intervals.
Across all sites, the median diagnostic interval was 46 days, ranging from 13 days for breast cancer to 116 days for lung cancer. It was 14% longer for Black patients (adjusted time ratio [ATR] 1.14, 95% confidence interval [CI] = 1.05 to 1.25) and 13% longer for Asian patients (ATR 1.13, 95% CI = 1.03 to 1.23) compared with White patients. Site-specific analyses showed that, for myeloma, lung, prostate, and colorectal cancer, the secondary care interval was longer in Asian and Black patients, who also had a longer primary care interval in breast and colorectal cancer. There was little evidence of ethnic differences in referral interval.
This study found evidence of ethnic differences in diagnostic intervals, with prolonged secondary care intervals for four common cancers and prolonged primary care intervals for two. Although these differences are relatively modest, they are unjustified and may indicate shortcomings in healthcare delivery that disproportionately affect ethnic minorities.
英国的亚裔和黑人患者癌症诊断间隔时间更长——即从在初级保健机构首次出现症状到癌症确诊之间的时间段。
确定诊断间隔时间的差异是否是由于初级保健、转诊或二级保健间隔时间延长所致。
对70971例在英国初级保健机构出现症状后被诊断患有七种癌症（乳腺癌、肺癌、前列腺癌、结直肠癌、食管胃癌、骨髓瘤、卵巢癌）的患者进行了一项队列研究。
从与癌症登记处相关联的初级保健和二级保健数据中提取症状出现和诊断的数据。初级保健间隔定义为首次初级保健就诊到二级保健转诊之间的时间段，转诊间隔定义为转诊到首次二级保健预约之间的时间段，二级保健间隔定义为首次二级保健预约到诊断之间的时间段。使用加速失效时间模型来研究所有四个间隔时间内的种族差异。
在所有部位，中位诊断间隔时间为46天，范围从乳腺癌的13天到肺癌的116天。与白人患者相比，黑人患者的诊断间隔时间长14%（调整时间比[ATR]1.14，95%置信区间[CI]=1.05至1.25），亚裔患者长13%（ATR 1.13，95%CI=1.03至1.23）。特定部位分析表明，对于骨髓瘤、肺癌、前列腺癌和结直肠癌，亚裔和黑人患者的二级保健间隔时间更长，在乳腺癌和结直肠癌方面，他们的初级保健间隔时间也更长。几乎没有证据表明转诊间隔时间存在种族差异。
本研究发现了诊断间隔时间存在种族差异的证据，四种常见癌症的二级保健间隔时间延长，两种癌症的初级保健间隔时间延长。尽管这些差异相对较小，但却是不合理的，可能表明医疗服务存在不足，对少数族裔产生了不成比例的影响。
