Race and colon cancer survival in an equal-access health care system.
Race and colon cancer survival in an equal-access health care system.
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DOI：
10.1158/1055-9965.epi-13-0143
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发表时间：
2013-06
期刊：
影响因子：
--
通讯作者：
Zhu K
中科院分区：
文献类型：
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作者：
Andaya AA;Enewold L;Zahm SH;Shriver CD;Stojadinovic A;McGlynn KA;Zhu K
研究表明，白人的结直肠癌存活率高于黑人。然而，目前尚不清楚种族差异是否是由于获得医疗保健的机会不平等或医疗保健以外的因素或两者兼而有之造成的。本研究评估了在平等医疗保健系统中非西班牙裔白人 (NHW) 和非西班牙裔黑人 (NHB) 结肠癌 (CC) 生存率是否存在差异，并检验了种族差异是否因人口统计和肿瘤特征而异。该研究纳入了 1998 年至 2007 年间被诊断患有 CC 的 2,537 名军事卫生系统患者。中位随访时间为 31.4 个月。 Cox 模型估计了种族的总体风险比 (HR) 和 95% 置信区间 (CI)，并按诊断年龄、性别和肿瘤分期进行分层。一般来说，NHW 和 NHB 之间的总生存期 (OS) 没有差异。然而，在 50 岁以下的患者中，NHB 的 OS 明显低于 NHW（HR：2.27，95% CI：1.48-3.49）。按性别和肿瘤分期进一步分层显示，这种种族差异仅限于该年龄组中的女性（HR：2.80，95％CI：1.30-6.00）和晚期疾病患者（HR：2.65，95％CI：1.38-5.08）。当 NHW 和 NHB 同等地获得医疗服务时，观察到相似的总体 CC 生存率；然而，50 岁以下患者的生存率存在明显的种族差异。这项研究表明，除了获得护理之外的其他因素可能与年轻患者而非老年患者 CC 生存率的种族差异有关。
Studies have shown that whites have a higher colorectal cancer survival rate than blacks. However, it is unclear whether racial disparities result from unequal access to medical care or factors other than healthcare access or both. This study assessed whether non-Hispanic Whites (NHWs) and non-Hispanic Blacks (NHBs) differ in colon cancer (CC) survival in an equal-access healthcare system and examined whether racial differences varied by demographic and tumor characteristics. The study included 2,537 Military Health System patients diagnosed with CC between 1998 and 2007. Median follow-up time was 31.4 months. Cox models estimated hazard ratios (HR) and 95% confidence intervals (CI) for race, overall and stratified by age at diagnosis, sex, and tumor stage. No difference in overall survival (OS) between NHWs and NHBs was observed in general. However, among patients younger than 50 years old, NHBs experienced significantly worse OS than NHWs (HR: 2.27, 95% CI: 1.48–3.49). Further stratification by sex and tumor stage showed that this racial disparity was confined to women (HR: 2.80, 95% CI: 1.30–6.00) and patients with distant stage disease (HR: 2.65, 95% CI: 1.38–5.08) in this age group. When medical care is equally available to NHWs and NHBs, similar overall CC survival was observed; however, evidence of racial differences in survival was apparent for patients younger than 50 years old. This study suggests that factors other than access to care may be related to racial disparities in CC survival among younger, but not older, patients.