Yang Danting, Karanth Shama D, Yoon Hyung-Suk, Yang Jae Jeong, Lou Xiwei, Bian Jiang, Zhang Dongyu, Guo Yi, Yaghjyan Lusine, Akinyemiju Tomi, Rodriguez Estelamari, Mehta Hiren J, Braithwaite Dejana
Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL.
University of Florida Health Cancer Center, Gainesville, FL.
JCO Oncol Adv. 2024 Dec 3;1:e2400008. doi: 10.1200/OA.24.00008. eCollection 2024.
In the United States, there are disparities in access to care for patients with non-small cell lung cancer (NSCLC) on the basis of socioeconomic and racial/ethnic factors. This study investigates the association between race/ethnicity and the utilization of immune checkpoint inhibitor (ICI) therapy among older patients with advanced NSCLC (aNSCLC).
This retrospective study used data from the SEER-Medicare-linked database. The cohort included patients (age 66 years or older) diagnosed with aNSCLC (stage III/IV) between March 2015 and December 2017, and they were followed through December 2019. Race/ethnicity was categorized as non-Hispanic (NH)-White, NH-Black, Hispanic, and Other. ICI therapy utilization was determined by identifying any usage of ICI agents (nivolumab, pembrolizumab, atezolizumab, durvalumab, ipilimumab, and cemiplimab-rwlc) from the Medicare database. Multivariable logistic regression models assessed the association between race/ethnicity and ICI therapy utilization (yes, no). Effect measure modification analyses were conducted by sex, socioeconomic status, and comorbidity.
The final sample included 26,836 patients; 76.2% were NH-White, 10.1% NH-Black, 5.7% Hispanic, and 8.0% Other. The overall ICI therapy utilization proportion was 17.8%, varying across ethnicities: NH-Black 14.1%, Hispanic 16.3%, NH-White 18.4%, and Other 18.5%. In comparison with NH-White patients, NH-Black patients were 15% less likely to receive ICI therapy (adjusted odds ratio, 0.85 [95% CI, 0.75 to 0.96]). Furthermore, the association between race/ethnicity and utilization of ICI therapy was modified by comorbidity status, sex, and socioeconomic status.
NH-Black patients with aNSCLC were less likely to receive ICI therapy than their NH-White counterparts. Our findings indicate the racial/ethnic disparities in ICI therapy utilization and call for further interventions to optimize access to care.
在美国，非小细胞肺癌（NSCLC）患者在获得医疗服务方面存在基于社会经济和种族/民族因素的差异。本研究调查老年晚期NSCLC（aNSCLC）患者的种族/民族与免疫检查点抑制剂（ICI）治疗使用之间的关联。
这项回顾性研究使用了与SEER - 医疗保险相关的数据库中的数据。该队列包括2015年3月至2017年12月期间诊断为aNSCLC（III/IV期）的患者（年龄66岁及以上），并随访至2019年12月。种族/民族分为非西班牙裔（NH）白人、NH黑人、西班牙裔和其他。ICI治疗的使用情况通过在医疗保险数据库中识别ICI药物（纳武单抗、帕博利珠单抗、阿特珠单抗、度伐利尤单抗、伊匹木单抗和西米普利单抗 - rwlc）的任何使用情况来确定。多变量逻辑回归模型评估种族/民族与ICI治疗使用（是，否）之间的关联。通过性别、社会经济地位和合并症进行效应测量修正分析。
最终样本包括26,836名患者；76.2%为NH白人，10.1%为NH黑人，5.7%为西班牙裔，8.0%为其他。ICI治疗的总体使用比例为17.8%，各民族有所不同：NH黑人14.1%，西班牙裔16.3%，NH白人18.4%，其他18.5%。与NH白人患者相比，NH黑人患者接受ICI治疗的可能性低15%（调整后的优势比，0.85 [95% CI，0.75至0.96]）。此外，种族/民族与ICI治疗使用之间的关联因合并症状态、性别和社会经济地位而有所改变。
患有aNSCLC的NH黑人患者比NH白人患者接受ICI治疗的可能性更小。我们的研究结果表明了ICI治疗使用中的种族/民族差异，并呼吁采取进一步干预措施以优化医疗服务的可及性。
