Racial and ethnic differences in the adoption of opportunistic salpingectomy for ovarian cancer prevention in the United States.
Racial and ethnic differences in the adoption of opportunistic salpingectomy for ovarian cancer prevention in the United States.
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DOI：
10.1016/j.ajog.2022.04.036
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发表时间：
2022-08
影响因子：
9.8
通讯作者：
中科院分区：
文献类型：
--
作者：
美国的临床医生已经迅速采用机会性输卵管切除术来预防卵巢癌。然而，关于机会性输卵管切除术采用的种族和民族差异知之甚少。妇科外科创新可能会在不同种族和民族群体中得到不同的采用，加剧了目前护理质量的差异。评估住院和门诊患者在机会性输卵管切除术采用方面的种族差异，并评估支持机会性输卵管切除术使用的国家指南对这些差异的影响。使用Premier Healthcare Database（一个包括美国700多家医院的全付款医院管理数据库）确定了2011-2018年期间接受子宫切除术并保留卵巢或手术绝育的650,905名18-50岁女性的样本。采用考虑医院水平聚类的多变量调整混合效应对数二项回归模型检验种族和民族与机会性输卵管切除术使用之间的关系。模型包括按手术年份（2011-2013[指南前]，2014-2018[指南后]）划分的种族和民族相互作用项，以检验机会性输卵管切除术采用的种族和民族差异是否随着支持机会性输卵管切除术使用的国家指南的发布而改变。2011-2018年，82792名女性接受了子宫切除术和机会性输卵管切除术（非西班牙裔白人：60.3%，非西班牙裔黑人：18.8%，西班牙裔：12.2%，非西班牙裔其他种族：8.7%），23398名女性接受了机会性输卵管切除术进行绝育（非西班牙裔白人：64.7%，非西班牙裔黑人：10.8%，西班牙裔：16.7%，非西班牙裔其他种族：7.8%）。涉及机会性输卵管切除术的子宫切除术比例从2011年的6.3%增加到2018年的59.7%（增长9.5倍），涉及机会性输卵管切除术的绝育手术比例从2011年的0.7%增加到2018年的19.4%（增长27.7倍）。在多变量调整模型中，非西班牙裔黑人（风险比：0.94,95%置信区间：0.92-0.97）、西班牙裔（风险比：0.98,95%置信区间：0.95-1.00）和非西班牙裔其他种族女性（风险比：0.93,95%置信区间：0.90-0.96）接受子宫切除术和机会性输卵管切除术的可能性低于非西班牙裔白人女性。与非西班牙裔白人妇女相比，非西班牙裔黑人妇女的种族、民族和手术年份之间存在显著的相互作用（P<0.001），在国家指南发布后，子宫切除术和机会性输卵管切除术的使用差异减少（风险比2011 - 2013:0.80,95% CI: 0.73-0.88；风险比2014 - 2018:0.98,95% CI: 0.95-1.01）。与非西班牙裔白人女性相比，非西班牙裔黑人女性接受机会性输卵管切除术绝育的可能性也更低（风险比：0.91,95%可信区间：0.88-0.95），手术年份没有差异（P=0.62）。子宫切除途径和手术年龄的分层分析显示了类似的结果。虽然机会性输卵管切除术预防卵巢癌在美国已被迅速采用，但我们的研究结果表明，它的采用在种族和民族群体中并不公平。非西班牙裔黑人、西班牙裔和非西班牙裔其他种族妇女比非西班牙裔白人妇女更不可能接受机会性输卵管切除术，即使在调整了社会人口统计学、临床、手术、医院和提供者特征之后。这些差异在支持机会性输卵管切除术的国家指南发布后仍然存在。未来的研究应侧重于了解这些差异的原因，以告知干预措施，促进机会性输卵管切除术使用的公平性。与非西班牙裔白人女性相比，非西班牙裔黑人、西班牙裔和非西班牙裔其他种族的女性更不可能接受机会性输卵管切除术来预防卵巢癌。
Clinicians in the United States have rapidly adopted opportunistic salpingectomy for ovarian cancer prevention. However, little is known about racial and ethnic differences in opportunistic salpingectomy adoption. Surgical innovations in gynecology may be adopted differentially across racial and ethnic groups, exacerbating current disparities in quality of care. To evaluate racial and ethnic differences in opportunistic salpingectomy adoption across inpatient and outpatient settings and assess the impact of national guidelines supporting opportunistic salpingectomy use on these differences. A sample of 650,905 women aged 18–50 years undergoing hysterectomy with ovarian conservation or surgical sterilization from 2011–2018 was identified using the Premier Healthcare Database, an all-payer hospital administrative database including over 700 hospitals across the United States. The association between race and ethnicity and opportunistic salpingectomy use was examined using multivariable-adjusted mixed-effects log-binomial regression models accounting for hospital-level clustering. Models included a race and ethnicity by year of surgery (2011–2013 [before guideline], 2014–2018 [after guideline]) interaction term to test whether racial and ethnic differences in opportunistic salpingectomy adoption changed with the release of national guidelines supporting opportunistic salpingectomy use. From 2011–2018, 82,792 women underwent hysterectomy and opportunistic salpingectomy (non-Hispanic White: 60.3%, non-Hispanic Black: 18.8%, Hispanic: 12.2%, non-Hispanic other race: 8.7%) and 23,398 women underwent opportunistic salpingectomy for sterilization (non-Hispanic White: 64.7%, non-Hispanic Black: 10.8%, Hispanic: 16.7%, non-Hispanic other race: 7.8%). The proportion of hysterectomy procedures involving an opportunistic salpingectomy increased from 6.3% in 2011 to 59.7% in 2018 (9.5-fold increase), and the proportion of sterilization procedures involving an opportunistic salpingectomy increased from 0.7% in 2011 to 19.4% in 2018 (27.7-fold increase). In multivariable-adjusted models, non-Hispanic Black (risk ratio: 0.94, 95% confidence interval: 0.92–0.97), Hispanic (risk ratio: 0.98, 95% confidence interval: 0.95–1.00), and non-Hispanic other race women (risk ratio: 0.93, 95% confidence interval: 0.90–0.96) were less likely to undergo hysterectomy and opportunistic salpingectomy than non-Hispanic White women. A significant interaction between race and ethnicity and year of surgery was noted in non-Hispanic Black compared to non-Hispanic White women (P<0.001), with a reduction in differences in hysterectomy and opportunistic salpingectomy use after national guideline release (risk ratio2011–2013: 0.80, 95% CI: 0.73–0.88; risk ratio2014–2018: 0.98, 95% CI: 0.95–1.01). Non-Hispanic Black women were also less likely to undergo an opportunistic salpingectomy for sterilization than non-Hispanic White women (risk ratio: 0.91, 95% confidence interval: 0.88–0.95), with no difference by year of surgery (P=0.62). Stratified analyses by hysterectomy route and age at surgery revealed similar results. Although opportunistic salpingectomy for ovarian cancer prevention has been rapidly adopted in the United States, our findings suggest that its adoption has not been equitable across racial and ethnic groups. Non-Hispanic Black, Hispanic, and non-Hispanic other race women are less likely to undergo opportunistic salpingectomy than non-Hispanic White women even after adjusting for sociodemographic, clinical, procedural, hospital, and provider characteristics. These differences persisted after the release of national guidelines supporting opportunistic salpingectomy use. Future research should focus on understanding the reasons for these differences to inform interventions that promote equity in opportunistic salpingectomy use. Non-Hispanic Black, Hispanic, and non-Hispanic other race women are less likely to undergo opportunistic salpingectomy for ovarian cancer prevention than non-Hispanic White women.
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影响因子：
16.6
作者：
Labidi-Galy SI;Papp E;Hallberg D;Niknafs N;Adleff V;Noe M;Bhattacharya R;Novak M;Jones S;Phallen J;Hruban CA;Hirsch MS;Lin DI;Schwartz L;Maire CL;Tille JC;Bowden M;Ayhan A;Wood LD;Scharpf RB;Kurman R;Wang TL;Shih IM;Karchin R;Drapkin R;Velculescu VE
通讯作者：
Velculescu VE
DOI：
10.1097/pas.0b013e3181cf3d79
发表时间：
2010-03
期刊：
The American journal of surgical pathology
影响因子：
--
作者：
Kurman RJ;Shih IeM
通讯作者：
Shih IeM
DOI：
10.1158/1940-6207.capr-21-0121
发表时间：
2021-12
期刊：
Cancer prevention research (Philadelphia, Pa.)
影响因子：
--
作者：
Karia PS;Joshu CE;Visvanathan K
通讯作者：
Visvanathan K
影响因子：
5.7
作者：
Groeneveld, Peter W.;Sonnad, Seema S.;Shea, Judy E.
通讯作者：
Shea, Judy E.
影响因子：
7.2
作者：
Borrero, Sonya;Schwarz, Eleanor B.;Ibrahim, Said A.
通讯作者：
Ibrahim, Said A.