Social disparities in survival after diagnosis with colorectal cancer: Contribution of race and insurance status
Social disparities in survival after diagnosis with colorectal cancer: Contribution of race and insurance status
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DOI：
10.1016/j.canep.2017.03.004
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发表时间：
2017-06-01
影响因子：
2.6
通讯作者：
Brenner, Hermann
中科院分区：
文献类型：
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作者：
Pulte, Dianne;Jansen, Lina;Brenner, Hermann
背景：少数民族和缺乏健康保险都是结直肠癌（CRC）低生存率的危险因素，但两者之间的相互作用尚未得到详细探讨。方法：对2007- 2013年在监测流行病学中登记的结直肠癌患者按种族/民族和保险类型进行1 - 5年生存率分析，并对最终结果数据库进行分析。计算共享脆弱模型，以进一步探讨在调整人口统计学和治疗变量后CRC特异性生存与保险状况之间的关系。结果：非西班牙裔白人（nHW）的年龄调整5年生存率为70.4%，非西班牙裔黑人（nHB）为62.7%，西班牙裔为70.2%，美洲原住民为64.7%，亚洲/太平洋岛民（API）为73.1%。在所有种族中，有医疗保险的患者生存率高于有医疗补助的患者，但生存率的差异因种族而异，医疗补助和无医疗保险与其他保险相比，nHW的差异最大，分别为+25.0%和+20.2%。在阶段和年龄特异性分析中观察到类似的结果，与其他组相比，nHW和API组的生存率始终较高。混杂校正后，在医疗补助和未参保人群中观察到crc特异性生存率的风险比分别为1.53和1.50。只有nHB与nHW的种族/民族差异仍然显著。结论：种族/民族和保险类型是影响结直肠癌患者生存预期的部分独立因素。在所有保险类型中，NHB的存活率都低于预期。Elsevier Ltd.出版。
Background: Both minority race and lack of health insurance are risk factors for lower survival in colorectal cancer (CRC) but the interaction between the two factors has not been explored in detail.Methods: One to 5-year survival by race/ethnic group and insurance type for patients with CRC diagnosed in 2007-13 and registered in the Surveillance Epidemiology, and EndResults: database were explored. Shared frailty models were computed to further explore the association between CRC specific survival and insurance status after adjustment for demographic and treatment variables.Results: Age-adjusted 5-year survival estimates were 70.4% for non-Hispanic whites (nHW), 62.7% for non-Hispanic blacks (nHB), 70.2% for Hispanics, 64.7% for Native Americans, and 73.1% for Asian/Pacific Islanders (API). Survival was greater for patients with insurance other than Medicaid for all races, but the differential in survival varied with race, with the greatest difference being seen for nHW at +25.0% and +20.2%, respectively, for Medicaid and uninsured versus other insurance. Similar results were observed for stage- and age-specific analyses, with survival being consistently higher for nHW and API compared to other groups. After confounder adjustment, hazard ratios of 1.53 and 1.50 for CRC-specific survival were observed for Medicaid and uninsured. Racial/ethnic differences remained significant only for nHB compared to nHW.Conclusions: Race/ethnic group and insurance type are partially independent factors affecting survival expectations for patients diagnosed with CRC. NHB had lower than expected survival for all insurance types. Published by Elsevier Ltd.