Survival among Black and White patients with renal cell carcinoma in an equal-access health care system.
Survival among Black and White patients with renal cell carcinoma in an equal-access health care system.
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DOI：
10.1007/s10552-015-0594-4
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发表时间：
2015-07
期刊：
影响因子：
--
通讯作者：
Zhu K
中科院分区：
文献类型：
--
作者：
Lin J;Zahm SH;Shriver CD;Purdue M;McGlynn KA;Zhu K
获得医疗保健的机会不平等可能是黑人肾细胞癌（RCC）患者比白人患者生存时间短的一个原因。没有研究调查在一个平等的卫生保健提供系统中，RCC患者的生存差异。本研究旨在研究美国国防部（DoD）军事卫生系统（MHS）中透明细胞RCC患者生存的种族差异，该系统为所有人提供平等的护理机会。这项研究使用了国防部的自动中央肿瘤登记处，在1988年至2004年期间，确定了2056名白人患者和370名黑人患者被诊断为透明细胞RCC。的。受试者随访至2007年，中位随访时间为4.8年。比较Kaplan-Meier生存曲线，并使用Cox模型估计不同种族与生存相关的风险比（hr）。在随访期间，1027名白人和158名黑人患者死亡。Kaplan-Meier曲线显示黑人患者的总生存率高于白人患者（Log Rank P=0.034）。在调整了人口统计学、肿瘤和治疗变量后，Cox模型显示总体上没有统计学上显著的种族差异（调整后的HR=1.08, 95% CI=0.90至1.29），也没有按年龄、性别或肿瘤分期分层。然而，在未接受手术的患者中，黑人患者的生存率低于白人。在MHS中，RCC患者的生存率没有种族差异，这可能与获得医疗保健的平等机会有关。改善可及性可以减少一般人群中RCC患者的生存差异。
Unequal access to health care may be a reason for shorter survival among black patients with renal cell carcinoma (RCC) than among their white counterparts. No studies have investigated survival disparity among RCC patients in an equal-access health care delivery system. This study aimed to examine racial differences in survival among clear cell RCC patients in the Department of Defense's (DoD) Military Health System (MHS), which provides equal access to care to all persons. The study used the DoD's Automated Central Tumor Registry to identify 2,056 white patients and 370 black patients diagnosed with clear cell RCC between 1988 and 2004. the. Subjects were followed through 2007 with a median follow up time of 4.8 years. Kaplan-Meier survival curves were compared and a Cox model was used to estimate the hazard ratios (HRs) associated with survival by race. During follow up, 1,027 white and 158 black patients died. The Kaplan-Meier curves showed that black patients had more favorable overall survival than did whites (Log Rank P=0.034). After adjustment for demographic, tumor, and treatment variables, the Cox model showed no statistically significant racial difference overall (adjusted HR=1.08, 95% CI=0.90 to 1.29) or stratified by age, sex or tumor stage. However, among patients who did not undergo surgery, black patients had poorer survival than whites. The lack of racial difference in survival among RCC patients in the MHS may be related to equal access to health care. Improved access could reduce the survival disparity among RCC patients in the general population.
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DOI：
10.1158/1055-9965.epi-13-0143
发表时间：
2013-06
期刊：
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
影响因子：
--
作者：
Andaya AA;Enewold L;Zahm SH;Shriver CD;Stojadinovic A;McGlynn KA;Zhu K
通讯作者：
Zhu K
影响因子：
6.6
作者：
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通讯作者：
Sadler, Georgia Robins
DOI：
10.1111/j.1532-5415.2000.tb04746.x
发表时间：
2000-07-01
影响因子：
6.3
作者：
Hegarty, V;Burchett, BM;Cohen, HJ
通讯作者：
Cohen, HJ
影响因子：
254.7
作者：
Siegel, Rebecca;Naishadham, Deepa;Jemal, Ahmedin
通讯作者：
Jemal, Ahmedin
影响因子：
120.7
作者：
ELEY, JW;HILL, HA;EDWARDS, BK
通讯作者：
EDWARDS, BK