Treatment differences between blacks and whites with colorectal cancer
Treatment differences between blacks and whites with colorectal cancer
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DOI：
10.1097/00005650-199609000-00008
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发表时间：
1996-09-01
期刊：
影响因子：
3
通讯作者：
Elixhauser, A
中科院分区：
文献类型：
--
作者：
Ball, JK;Elixhauser, A
目标.作者在全国范围内对20，000多例结直肠癌住院患者的治疗进行了种族间差异研究。为了减少可以解释治疗差异的临床异质性，根据原发性结直肠肿瘤、肿瘤后遗症和转移的诊断，将住院治疗分为相对同质的亚组。将手术分为临床相关治疗类型。多变量技术控制患者人口统计学，保险状况，其他临床因素和供应商特征的差异。黑人比白人更有可能因肿瘤后遗症住院，诊断表明晚期疾病，这可能会引起未管理或管理不善的癌症的影响。只有病情最严重的患者的住院死亡率与此相当。另外，黑人的住院死亡率比白人高59%至98%。就手术类型而言，仅对病情最严重的患者进行同等治疗。在病情较轻的患者中，黑人接受主要治疗程序的可能性低于白人。多项研究结果表明，患有结直肠癌的黑人住院条件更严重，治疗积极性低于白人。在医疗保健改革的时代，要克服这种不计保险影响的差异，可能需要的不仅仅是全民保险。
OBJECTIVES. The authors examine interracial variations in treatment for over 20,000 patients hospitalized with colorectal cancer in a national sample of hospitals.METHODS. To reduce clinical heterogeneity that could explain differences in treatment, hospitalizations were classified into relatively homogeneous subgroups based on diagnoses indicating primary colorectal tumor, oncologic sequelae, and metastasis. Procedures were classified into clinically relevant treatment types. Multivariate techniques controlled for differences in patient demographics, insurance status, other clinical factors, and provider characteristics.RESULTS. Blacks were more likely than whites to be hospitalized with oncologic sequelae, diagnoses indicating advanced disease, which may capture the effects of unmanaged or poorly managed cancer. Inpatient mortality was equivalent only for the most severely ill. Otherwise, the odds of inpatient mortality were 59% to 98% higher for blacks than whites. Treatment, in terms of procedure type, was equivalent only for the sickest patients. Among the less severely ill, blacks were less likely than whites to receive major therapeutic procedures.CONCLUSIONS. Multiple findings suggest that blacks with colorectal cancer were hospitalized with more severe conditions and treated less aggressively than whites. In an era of health-care reform, such differences, which are net of insurance effects, may require more than universal insurance coverage to be overcome.