Sociodemographic Survival Disparities for Lung Cancer in the United States, 2000-2016.
Sociodemographic Survival Disparities for Lung Cancer in the United States, 2000-2016.
复制标题
2000-2016 年美国肺癌的社会人口生存差异。
DOI：
10.1093/jnci/djac144
复制
发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Meza,Rafael
中科院分区：
文献类型：
--
作者：
Brouwer,AndrewF;Engle,JasonM;Jeon,Jihyoun;Meza,Rafael
了解患者和肿瘤特征对肺癌生存的影响有助于建立个性化的预后模型和识别健康差异。方法从2000-2016年的监测、流行病学和最终结果数据库中筛选出557 555例年龄在25岁及以上诊断为肺或支气管癌的患者。我们使用多变量比例风险模型估计了人口统计学（性别、年龄、种族和民族）、肿瘤（分期、组织学、诊断年份）和地理特征（人口普查区域水平的城市化程度、社会经济地位[SES]）以及选定的相互作用对肺癌特异性死亡率的风险比（HR）。结果女性肺癌特异性死亡生存率（低风险）高于男性（HR = 0.83, 95%可信区间[CI] = 0.82 ~ 0.83）。危险因种族和民族而异。区域性肿瘤（HR = 2.41, 95% CI = 2.37 ~ 2.44）和远端肿瘤（HR = 6.61, 95% CI = 6.53 ~ 6.69）与局部肿瘤相比生存率较低（风险较高）。与非小细胞肿瘤相比，小细胞肿瘤的生存率较低（HR = 1.19, 95% CI = 1.18 ~ 1.20）。与2000-2009年诊断的患者相比，2009年以后诊断的患者的风险较低（HR = 0.86, 95% CI = 085 ~ 0.86）。在调整人口普查区域水平SES后，肺癌特异性生存率不依赖于城市化，但生存率随着人口普查区域水平SES的降低而降低。非西班牙裔黑人和白人患者之间的生存差异在年轻患者和局部肿瘤中更大，并随着人口普查区水平的SES而增加。在年轻患者和局部肿瘤中，性别差异最大。结论肺癌诊断后生存率的差异仍然存在，交叉模式表明不同的治疗途径和质量。需要努力确保高危人群得到符合指南的治疗。
BackgroundUnderstanding the impact of patient and tumor characteristics on lung cancer survival can help build personalized prognostic models and identify health disparities.MethodsWe identified 557 555 patients aged 25 years and older diagnosed with lung or bronchus carcinoma from the Surveillance, Epidemiology, and End Results database, 2000-2016. We estimated hazard ratios (HR) for demographic (sex, age, race and ethnicity), tumor (stage, histology, year of diagnosis), and geographic characteristics (census tract–level urbanicity, socioeconomic status [SES]), as well as selected interactions, on the rate of lung cancer–specific death using multivariable proportional hazards models.ResultsWomen had a higher survival (lower hazard) of lung cancer–specific death than men (HR = 0.83, 95% confidence interval [CI] = 0.82 to 0.83). Hazards differed by race and ethnicity. Regional (HR = 2.41, 95% CI = 2.37 to 2.44) and distant (HR = 6.61, 95% CI = 6.53 to 6.69) tumors were associated with a lower survival (higher hazard) than localized tumors. Small cell tumors were associated with a lower survival (HR = 1.19, 95% CI = 1.18 to 1.20) than non–small cell tumors. Patients diagnosed after 2009 had lower hazards (HR = 0.86, 95% CI = 085 to 0.86) than those diagnosed 2000-2009. Lung cancer–specific survival did not depend on urbanicity after adjusting for census tract–level SES, but survival decreased with decreasing census tract–level SES. Differences in survival between non-Hispanic Black and White patients were greater for younger patients and localized tumors and increased with census tract–level SES. Differences by sex were greatest for young patients and localized tumors.ConclusionsDisparities in survival after lung cancer diagnosis remain, with intersectional patterns suggesting differential access to and quality of care. Efforts are needed to ensure that high-risk groups receive guideline-concordant treatment.