DETERMINANTS OF BLACK-WHITE DIFFERENCES IN COLON-CANCER SURVIVAL
DETERMINANTS OF BLACK-WHITE DIFFERENCES IN COLON-CANCER SURVIVAL
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DOI：
10.1093/jnci/87.22.1686
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发表时间：
1995-11-15
期刊：
影响因子：
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通讯作者：
EDWARDS, BK
中科院分区：
文献类型：
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作者：
MAYBERRY, RM;COATES, RJ;EDWARDS, BK
背景：黑人结肠癌的存活率低于白人，这可能与确诊时疾病的晚期以及黑人和白人之间的社会经济差异有关。黑人和白人之间的结肠癌存活率差异是有据可查的，少数研究这种差异的研究受到所考虑的解释因素的数量和类型的限制，目的：我们分析了美国国家癌症研究所黑人/白人癌症存活期研究的数据，以确定1)哪些特征可能导致结肠癌存活率的种族差异；2)如果调整了这些特征后，黑人和白人患者之间的存活率差异仍然存在。方法：这项前瞻性研究包括454名黑人和分层随机抽样的521名白人，年龄20-79岁，从1985年1月1日至1986年12月31日确诊为结肠癌，居住在亚特兰大、新奥尔良和旧金山/奥克兰的大都市居民，于1990年12月31日截尾随访，在调整潜在解释因素(包括社会人口学因素、并发疾病、诊断阶段、肿瘤特征和治疗)后，采用Cox比例风险回归估计黑人相对于白人的死亡率，所有P值均通过统计学意义的双尾检验计算。结果：在调整了年龄、性别和地理区域后，黑人与白人的死亡风险比(HR)为1.5(95%可信区间[CI]=1.2~1.9)，表明黑人患者的死亡风险比白人患者高50%，进一步调整分期后，额外的癌症死亡率降至20%(HR=1.2；95%CI=1.0-1.5)，将总体种族差异的超额死亡率从50%降低到20%或60%，虽然经贫困调整将超额死亡率降低了20%，但同时调整分期和贫困并没有进一步缩小种族差异。在II和III期疾病患者中，黑人的存活率低于白人(HR=1.8；95%CI=1.0-3.1和HR=1.5；95%CI=1.0-2.3)，在那些患有转移性疾病(IV期)的患者中，白人和黑人的生存率相似，结论：在黑人中观察到的过高的结肠癌死亡率中，确诊阶段占一半以上，贫困和其他社会经济条件、一般健康状况、肿瘤特征和一般治疗模式不能进一步解释黑人剩余的生存劣势，暗示：由于种族差异仅限于早期阶段，未来的研究应该调查黑人在确诊时是否有更晚期的疾病，以及是否由于年龄不足而提供较低侵袭性的治疗，
Background: Blacks have lower survival rates for colon cancer than whites, possibly related to more advanced stages of disease at diagnosis and to socioeconomic differences between blacks and whites, White the black/white difference in colon cancer survival is well documented, the few studies that have investigated this difference have been limited by the modest number and type of explanatory factors that were considered, Purpose: We analyzed data from the National Cancer Institute Black/White Cancer Survival Study to determine 1) what characteristics might contribute to the racial difference in colon cancer survival and 2) if a survival disparity remained between black and white patients after adjustment was made for these characteristics. Methods: This prospective study included 454 blacks and a stratified random sample of 521 whites, aged 20-79 years, with cancer of the colon diagnosed from January 1, 1985, through December 31, 1986, and who were residents of the metropolitan areas of Atlanta, New Orleans, and San Francisco/Oakland, Follow-up was truncated on December 31, 1990, Cox proportional hazards regression was used to estimate the death rate among blacks relative to that among whites after adjustment for potential explanatory factors, including sociodemographic factors, concurrent (comorbid) medical conditions, stage at diagnosis, tumor characteristics, and treatment, All P values were calculated from two-tailed tests of statistical significance, Results: After adjustment for age, sex, and geographic area, the black-to-white mortality hazard ratio (HR) was 1.5 (95% confidence interval [CI] = 1.2-1.9), indicating that the risk of death among black patients was 50% higher than that among white patients, Further adjustment for stage reduced the excess cancer mortality to 20% (HR = 1.2; 95% CI = 1.0-1.5), decreasing the overall racial difference in excess mortality from 50% to 20% or to a 60% reduction in excess mortality, Although adjustment for poverty reduced the excess mortality by 20%, adjusting for both stage and poverty did not further reduce the racial difference, Among patients with stages II and III disease, blacks had lower survival rates than whites (HR = 1.8; 95% CI = 1.0-3.1 and HR = 1.5; 95% CI = 1.0-2.3, respectively), Among those patients with metastatic disease (stage IV), survival was similar for whites and blacks, Conclusions: Stage at diagnosis accounted for more than half of the excess colon cancer mortality observed among blacks, Poverty and other socioeconomic conditions, general health status, tumor characteristics, and general patterns of treatment did not further explain the remaining survival disadvantage among blacks, Implications: Because the racial disparity was confined to earlier stages, future studies should investigate whether blacks have more advanced disease at diagnosis and whether less aggressive treatment is provided because of understaging,