非霍奇金淋巴瘤中的种族差异：利用美国国防部中央癌症登记处和监测、流行病学和最终结果（SEER）项目的数据进行平行生存分析
Racial disparity in Non-Hodgkin Lymphoma: Parallel survival analysis with data from the DoD central cancer registry and SEER.
作者信息
Lin Jie, Dew Alexander A, Shriver Craig D, Zhu Kangmin
机构信息
Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA.
John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, USA.
出版信息
Ann Epidemiol. 2025 Jun;106:67-74. doi: 10.1016/j.annepidem.2025.04.016. Epub 2025 May 1.
PURPOSE
Barriers to health care access may contribute to the poorer survival of Black patients with Non-Hodgkin Lymphoma (NHL) than their White counterparts in the U.S. general population. The Department of Defense's (DoD) Military Health System (MHS) provides universal or equal health care access to all its beneficiaries. This study compared overall survival of NHL patients by race in the MHS and U.S. general population, respectively, and aimed to provide evidence on the role of universal health care in reducing racial disparity.
METHODS
The MHS Patients were identified from the DoD's Central Cancer Registry (CCR) and the patients from the U.S. general population were identified from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program. A retrospective cohort study was conducted comparing survival of major NHL subtypes by race in the CCR and the SEER cohorts, respectively.
RESULTS
Non-Hispanic Black patients and Non-Hispanic White patients in the CCR cohort had similar survival in Cox regression models sequentially adjusted for different sets of confounders. The hazard ratios (HRs) and 95 % confidence intervals (CIs) comparing Black to White patients for diffuse large B-cell lymphoma (DLBCL), chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), and other NHLs were 1.25 (0.89-1.78), 0.74 (0.39-1.42), and 1.25 (0.89-1.77) in the full models, respectively. In contrast, Black patients in the SEER cohort exhibited significantly worse survival than White patients in all models adjusting for the same sets of confounders. The HRs were 1.46 (95 % CI= 1.40-1.52), 1.57 (95 % CI=1.48-1.67), and 1.61 (95 % CI=1.54-1.68) in the full models for DLBCL, CLL/SLL and other NHL, respectively.
CONCLUSIONS
Our study supported universal access to health care as an important factor in reducing survival racial disparity among NHL patients.
目的
在美国普通人群中，获得医疗保健的障碍可能导致非霍奇金淋巴瘤（NHL）黑人患者的生存率低于白人患者。美国国防部（DoD）的军事医疗系统（MHS）为其所有受益人提供普遍或平等的医疗保健服务。本研究分别比较了MHS和美国普通人群中NHL患者按种族划分的总生存率，旨在提供关于全民医疗保健在减少种族差异方面作用的证据。
方法
从国防部中央癌症登记处（CCR）识别MHS患者，从美国国立癌症研究所的监测、流行病学和最终结果（SEER）计划中识别美国普通人群的患者。进行了一项回顾性队列研究，分别比较CCR和SEER队列中主要NHL亚型按种族划分的生存率。
结果
在依次针对不同混杂因素集进行调整的Cox回归模型中，CCR队列中的非西班牙裔黑人患者和非西班牙裔白人患者具有相似的生存率。在完整模型中，弥漫性大B细胞淋巴瘤（DLBCL）、慢性淋巴细胞白血病/小淋巴细胞淋巴瘤（CLL/SLL）和其他NHL中，黑人患者与白人患者相比的风险比（HR）和95%置信区间（CI）分别为1.25（0.89 - 1.78）、0.74（0.39 - 1.42）和1.25（0.89 - 1.77）。相比之下，在针对相同混杂因素集进行调整的所有模型中，SEER队列中的黑人患者生存率显著低于白人患者。DLBCL、CLL/SLL和其他NHL完整模型中的HR分别为1.46（95%CI = 1.40 - 1.52）、1.57（95%CI = 1.48 - 1.67）和1.61（95%CI = 1.54 - 1.68）。
结论
我们的研究支持全民医疗保健是减少NHL患者生存种族差异的一个重要因素。
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