Disparity in checkpoint inhibitor utilization among commercially insured adult patients with metastatic lung cancer.
Disparity in checkpoint inhibitor utilization among commercially insured adult patients with metastatic lung cancer.
复制标题
商业保险成年转移性肺癌患者在检查点抑制剂使用方面存在差异。
DOI：
10.1093/jnci/djac203
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Shih,Ya-ChenTina
中科院分区：
文献类型：
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作者：
Li,Meng;Liao,Kaiping;Chen,AliceJ;Cascone,Tina;Shen,Yu;Lu,Qian;Shih,Ya-ChenTina
BackgroundThere is a lack of evidence from nationwide samples on the disparity of initiating immune checkpoint inhibitors（ICI）after metastatic lung cancer diagnosis.MethodsWe identified metastatic lung cancer patients diagnosed between 2015 and 2020 from a large，nationwide commercial claims database.我们使用考克斯比例风险模型分析了从转移性肺癌诊断到ICI治疗的时间。自变量包括县级指标（种族化人口百分比的五分位数、贫困人口百分比的五分位数、城市化程度和医学肿瘤学家的密度）和患者特征（年龄、性别、Charlson合并症指数、医疗保险优势和诊断年份）。所有测试均为双侧。ResultsA共17 022例患者被纳入。 种族化人口比例较大的县似乎更加城市化，贫困居民比例更高，医学肿瘤学家的密度更高。在考克斯分析中，第二、第三、第四和最高五分位数种族化人群百分比的校正风险比为0.89（95%置信区间[CI] = 0.82至0.98），0.85（95%CI = 0.78 ~ 0.93）、0.78（95%CI = 0.71 ~ 0.86）和0.71（95%CI = 0.62 ~ 0.81）。较慢的ICI治疗启动是由县的西班牙裔人口和其他非黑色racialized groups. ConclusionsCommercialized百分比最高的转移性肺癌患者居住在县更大的种族化人口的百分比有较慢的ICI治疗肺癌诊断后启动，尽管更大的密度肿瘤学家在他们的邻居。
BackgroundThere is a lack of evidence from nationwide samples on the disparity of initiating immune checkpoint inhibitors (ICIs) after metastatic lung cancer diagnosis.MethodsWe identified metastatic lung cancer patients diagnosed between 2015 and 2020 from a large, nationwide commercial claims database. We analyzed the time from metastatic lung cancer diagnosis to ICI therapy using Cox proportional hazard models. Independent variables included county-level measures (quintiles of percentage of racialized population, quintiles of percentage of population below poverty, urbanity, and density of medical oncologists) and patient characteristics (age, sex, Charlson comorbidity index, Medicare Advantage, and year of diagnosis). All tests were 2-sided.ResultsA total of 17 022 patients were included. Counties with a larger proportion of racialized population appeared to be more urban, have a greater percentage of its residents in poverty, and have a higher density of medical oncologists. In Cox analysis, the adjusted hazard ratio of the second, third, fourth, and highest quintile of percentage of racialized population were 0.89 (95% confidence interval [CI] = 0.82 to 0.98), 0.85 (95% CI = 0.78 to 0.93), 0.78 (95% CI = 0.71 to 0.86), and 0.71 (95% CI = 0.62 to 0.81), respectively, compared with counties in the lowest quintile. The slower ICI therapy initiation was driven by counties with the highest percentage of Hispanic population and other non-Black racialized groups.ConclusionsCommercially insured patients with metastatic lung cancer who lived in counties with greater percentage of racialized population had slower initiation of ICI therapy after lung cancer diagnosis, despite greater density of oncologists in their neighborhood.