Racial differences in treatment and outcomes among patients with early stage bladder cancer.
Racial differences in treatment and outcomes among patients with early stage bladder cancer.
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DOI：
10.1002/cncr.24701
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发表时间：
2010-01-01
期刊：
影响因子：
6.2
通讯作者：
Birkmeyer, John D.
中科院分区：
文献类型：
--
作者：
Hollenbeck, Brent K.;Dunn, Rodney L.;Ye, Zaojun;Hollingsworth, John M.;Lee, Cheryl T.;Birkmeyer, John D.
Black patients are at greater of risk of death from bladder cancer than white patients. Potential explanations for this disparity include a more aggressive phenotype and delays in diagnosis resulting in higher stage disease. Alternatively, black patients might receive lower quality of care, which may explain this difference. Using SEER-Medicare data for the years 1992–2002, we identified patients with early stage bladder cancer. We fitted multivariable models to measure relationships between race and mortality, adjusting for differences in patients and treatment intensity. Next, we fitted shared frailty proportional hazards models to evaluate whether the disparity is explained by differences in the quality of care provided. Compared to white patients (n=14,271), black patients (n=342) were more likely to undergo restaging resection (12.0% vs. 6.5%, p<0.01) and urine cytologic evaluation (36.8% vs. 29.7%, p<0.01), and yet received fewer endoscopic evaluations (4.0 vs. 5.0, p<0.01). The use of aggressive therapies (cystectomy, systemic chemotherapy, radiation) was similar among black and white patients (12.0% vs. 10.2%, respectively, p=0.31). Although blacks had a greater risk of death compared to whites (HR 1.23, 95% CI 1.07–1.42), this risk was only modestly attenuated after adjusting for differences in treatment intensity and provider effects (HR 1.22, 95%CI 1.06–1.42). Although differences in initial treatment are evident, they do not appear to be systematic and are of unclear clinical significance. While black patients are at higher risk of death, this disparity does not appear to be due to differences in the intensity or quality of care provided.
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DOI：
10.1093/jnci/95.8.588
发表时间：
2003-04-16
期刊：
JOURNAL OF THE NATIONAL CANCER INSTITUTE
影响因子：
--
作者：
Schrag, D;Hsieh, LJ;Begg, CB
通讯作者：
Begg, CB
DOI：
10.1093/jnci/93.23.1822
发表时间：
2001-12-05
期刊：
JOURNAL OF THE NATIONAL CANCER INSTITUTE
影响因子：
--
作者：
Penson, DF;Albertsen, PC;Stanford, JL
通讯作者：
Stanford, JL
影响因子：
7.2
作者：
Klabunde, CN;Potosky, AL;Warren, JL
通讯作者：
Warren, JL
影响因子：
158.5
作者：
Bach, PB;Cramer, LD;Begg, CB
通讯作者：
Begg, CB
影响因子：
120.7
作者：
Liu, Jerome H.;Zingmond, David S.;Ko, Clifford Y.
通讯作者：
Ko, Clifford Y.