Racial Disparities and Treatment Trends in a Large Cohort of Elderly African Americans and Caucasians With Colorectal Cancer, 1991 to 2002
Racial Disparities and Treatment Trends in a Large Cohort of Elderly African Americans and Caucasians With Colorectal Cancer, 1991 to 2002
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DOI：
10.1002/cncr.23924
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发表时间：
2008-12-15
期刊：
影响因子：
6.2
通讯作者：
Du, Xianglin L.
中科院分区：
文献类型：
--
作者：
White, Arica;Liu, Chih-Chin;Du, Xianglin L.
背景在接受结肠直肠癌治疗的患者中已经证明了种族差异。然而，很少有人知道这些差距是否随着时间的推移而改变。本研究的目的是确定1991年至2002年接受标准治疗的种族差异是否有所下降。研究人群包括59，803名年龄≥ 65岁的高加索人和非洲裔美国人，他们在1991年至2002年期间被诊断患有结直肠癌（美国癌症联合委员会分期1，11和111），并从监测，流行病学和最终结果计划/Medicare链接数据库中确定。结直肠癌的标准治疗是根据国家癌症研究所的医师数据查询指南定义的。对接受标准治疗的粗百分比、年龄和性别校正百分比以及比值比（OR）进行统计。从1991年到2002年，白人（从24.5%到22.4%）和非洲裔美国人（从30.4%到26.4%）中未接受标准治疗的结直肠癌患者百分比均有所下降。总体而言，非裔美国人接受标准治疗的可能性比白人低16%（OR，0.84; 95%置信区间[CI]，0.78-0.90），但在调整其他因素后，差异并不显著（OR，0.96; 95% CI，0.88-1.05）。未接受标准治疗的差距相对稳定，1997年达到峰值（7.2%），1999年至2002年下降（从7.1%降至4%）。接受标准治疗的结直肠癌患者比例随着时间的推移而增加，但近年来差异仍然存在并有所减少。未来的研究应包括其他种族群体，并应纳入可能导致治疗差异的供应商和系统因素。Cancer 2008;113：3400-9. (C)2008年美国癌症协会
BACKGROUND. Racial differences have been demonstrated in patients who receive treatment for colorectal cancer. However, little is known about whether these disparities have changed over time. The objective of this study was to determine whether racial disparities in receiving standard therapy have declined between 1991 and 2002.METHODS. The study population consisted of 59,803 Caucasians and African Americans aged >= 65 years who were diagnosed with colorectal cancer (American Joint Committee on Cancer stages 1, 11, and 111) between 1991 and 2002 and were identified from the Surveillance, Epidemiology, and End Results Program/Medicare-linked database. Standard therapy for colorectal cancer was defined based on the Physician Data Query guidelines from the National Cancer Institute. The crude and age- and sex-adjusted percentages and the odds ratios (ORs) of receiving standard therapy were reported.RESULTS. From 1991 to 2002, the percentage of patients who did not receive standard therapy for colorectal cancer decreased for both Caucasians (from 24.5% to 22.4%) and African Americans (from 30.4% to 26.4%). Overall, African Americans were 16% less likely to receive standard therapy for colorectal cancer (OR, 0.84; 95% confidence interval [CI], 0.78-0.90) than Caucasians, but the difference was not significant after the analysis was adjusted for other factors (OR, 0.96; 95% CI, 0.88-1.05). The gap for not receiving standard therapy was relatively stable, peaked in 1997 (7.2%), and decreased from 1999 to 2002 (from 7.1% to 4%).CONCLUSIONS. The percentage of patients receiving standard therapy for colorectal cancer increased over time, but disparities remained and decreased in recent years. Future studies should include other ethnic groups and should incorporate provider and system factors that may contribute to treatment disparities. Cancer 2008;113:3400-9. (C) 2008 American Cancer Society