Colon Cancer Disparities in Stage at Presentation and Time to Surgery for Asian Americans, Native Hawaiians, and Pacific Islanders: A Study with Disaggregated Ethnic Groups.
Colon Cancer Disparities in Stage at Presentation and Time to Surgery for Asian Americans, Native Hawaiians, and Pacific Islanders: A Study with Disaggregated Ethnic Groups.
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DOI：
10.1245/s10434-023-13339-0
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发表时间：
2023-09
影响因子：
3.7
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亚裔美国人、夏威夷原住民和太平洋岛民(AANHPI)群体在护理障碍方面存在巨大差异，可能表现为在陈述和获得治疗的阶段存在差异。因此，我们将AANHPI患者定性为0-IV期结肠癌，并检验了(1)发病时的分期和(2)手术时间与白人患者的差异。我们评估了2004年至2016年国家癌症数据库(NCDB)中所有0-IV期结肠癌患者，他们是白人、中国人、日本人、菲律宾人、夏威夷原住民、韩国人、越南人、老挝人、苗族人、柬埔寨人、泰国人、亚洲印度人或巴基斯坦人以及太平洋岛民。多变量有序Logistic回归定义了(1)表现为晚期结肠癌的患者和(2)0-III期结肠癌患者在诊断后60天与30-59天和30天后在≥接受手术的调整优势比(95%可信区间(CI))，并根据社会人口/临床因素进行了调整。在694,876名患者中，日本人[AOR1.08(95%可信区间1.01~1.15)，P<0.001]，菲律宾[AOR=1.17(95%CI 1.09~1.25)，P<0.001]，韩国[AOR=1.09(95%CI 1.01~1.18)，P<0.05]，老挝[AOR=1.51(95%CI 1.17~1.95)，P<0.05；柬埔寨、泰国、太平洋岛民[AOR1.33(95%CI1.04-1.70)，P0.01]、泰国[AOR1.60(95%CI1.22-2.10)，p=0.001]和太平洋岛民[AOR1.41(95%CI1.20-1.67)，p；<；(0.001)]患者比白人患者更容易患上更晚期的结肠癌。中国人[AOR1.27(95%CI1.17-1.38)，p<；0.001]，日语[AOR1.23(95%CI1.10-1.37]，p<；0.001]，菲律宾[AOR1.36(95%CI1.22-1.52)，p<；0.001]，韩语[AOR1.16(95%CI1.02-1.32)，p<；与白人患者相比，越南患者更有可能经历更长的手术时间。在AANHPI亚组之间进行比较时，差异仍然存在。我们的发现揭示了AANHPI亚组中种族/民族在表现阶段和手术时间方面的关键差异。分类后的异质性强调了检查和解决获取障碍和临床差异的重要性。网上版载有补充材料，可在10.1245/s10434-023-13339-0查阅。
Vast differences in barriers to care exist among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) groups and may manifest as disparities in stage at presentation and access to treatment. Thus, we characterized AANHPI patients with stage 0–IV colon cancer and examined differences in (1) stage at presentation and (2) time to surgery relative to white patients. We assessed all patients in the National Cancer Database (NCDB) with stage 0–IV colon cancer from 2004 to 2016 who identified as white, Chinese, Japanese, Filipino, Native Hawaiian, Korean, Vietnamese, Laotian, Hmong, Kampuchean, Thai, Asian Indian or Pakistani, and Pacific Islander. Multivariable ordinal logistic regression defined adjusted odds ratios (AORs), with 95% confidence intervals (CI), of (1) patients presenting with advanced stage colon cancer and (2) patients with stage 0–III colon cancer receiving surgery at ≥ 60 days versus 30–59 days versus < 30 days postdiagnosis, adjusting for sociodemographic/clinical factors. Among 694,876 patients, Japanese [AOR 1.08 (95% CI 1.01–1.15), p < 0.05], Filipino [AOR 1.17 (95% CI 1.09–1.25), p < 0.001], Korean [AOR 1.09 (95% CI 1.01–1.18), p < 0.05], Laotian [AOR 1.51 (95% CI 1.17–1.95), p < 0.01], Kampuchean [AOR 1.33 (95% CI 1.04–1.70), p < 0.01], Thai [AOR 1.60 (95% CI 1.22–2.10), p = 0.001], and Pacific Islander [AOR 1.41 (95% CI 1.20–1.67), p < 0.001] patients were more likely to present with more advanced colon cancer compared with white patients. Chinese [AOR 1.27 (95% CI 1.17–1.38), p < 0.001], Japanese [AOR 1.23 (95% CI 1.10–1.37], p < 0.001], Filipino [AOR 1.36 (95% CI 1.22–1.52), p < 0.001], Korean [AOR 1.16 (95% CI 1.02–1.32), p < 0.05], and Vietnamese [AOR 1.55 (95% CI 1.36–1.77), p < 0.001] patients were more likely to experience greater time to surgery than white patients. Disparities persisted when comparing among AANHPI subgroups. Our findings reveal key disparities in stage at presentation and time to surgery by race/ethnicity among AANHPI subgroups. Heterogeneity upon disaggregation underscores the importance of examining and addressing access barriers and clinical disparities. The online version contains supplementary material available at 10.1245/s10434-023-13339-0.
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