Changes in Racial Disparities in Mortality After Cancer Surgery in the US, 2007-2016.
Changes in Racial Disparities in Mortality After Cancer Surgery in the US, 2007-2016.
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DOI：
10.1001/jamanetworkopen.2020.27415
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发表时间：
2020-12-01
影响因子：
13.8
通讯作者：
Figueroa JF
中科院分区：
文献类型：
--
作者：
Lam MB;Raphael K;Mehtsun WT;Phelan J;Orav EJ;Jha AK;Figueroa JF
从2007年到2016年，黑人和白色患者之间癌症手术后死亡率的差异是什么？在这项对870 929例10年以上癌症手术的横断面研究中，黑人和白色患者癌症手术后的总体死亡率均下降;然而，未观察到黑人和白色患者之间的死亡率差距显著缩小。死亡率的改善主要与院内因素有关。总体而言，黑人和白色患者的癌症手术后死亡率似乎都有所改善，但黑人和白色患者之间的癌症手术死亡率差距仍然存在，而且似乎没有缩小。种族差异在癌症护理中有很好的记录。总体而言，在美国，黑人患者的术后死亡率历来高于白色患者。然而，目前尚不清楚癌症手术后死亡率的种族差异是否随着时间的推移而改变。研究10年来黑人和白色患者以及9种特定癌症患者的癌症手术后死亡率差异是否发生了变化以及如何发生变化。在这项横断面研究中，使用国家医疗保险数据来检查黑人和白色患者术后死亡率的10年（2007年1月1日至2016年11月30日）变化。数据分析于2019年8月6日至12月31日进行。参与者包括参加Medicare Part A的付费服务受益人，他们接受了9种常见癌症手术的大手术切除术：结直肠癌，膀胱癌，食管癌，肾癌，肝癌，卵巢癌，胰腺癌，肺癌或前列腺癌。黑人和白色患者之间的癌症手术。风险调整后的30天全因术后死亡率（总体和9种特定类型癌症手术）。在10年的研究期间，共进行了870929例癌症手术。在基线年，共有103446例患者接受了癌症手术（96210例白色患者和7236例黑人患者）。黑人患者略年轻（平均[SD]年龄，73.0 [6.4] vs 74.5 [6.8]岁），黑人男性少于白色男性（3986 [55.1%] vs 55527 [57.7%]）。黑人（-0.12%; 95%CI，每年-0.17%至0.06%）和白色（-0.14%; 95%CI，每年-0.16%至0.13%）患者癌症手术后的总体国家死亡率较低。这些降低主要归因于院内死亡率的改善（黑人患者：每年0.10%; 95% CI，−0.15%至−0.05%; P < .001;白色患者：0.13%; 95% CI，−0.14%至−0.11%; P < .001）与院间死亡率的改善。在9种不同的癌症手术中，研究期间黑人和白色患者之间的死亡率变化无显著差异（例如，前列腺癌：0.35; 95% CI，0.02-0.68;肺癌：0.61; 95% CI，−0.21至1.44）。这些发现为政策制定者提供了关于癌症手术后种族差异可能减少的喜忧参半的消息。尽管黑人和白色患者的术后癌症手术死亡率均有所改善，但黑人和白色患者之间的总体死亡率差距或个体癌症手术之间的死亡率差距似乎没有缩小。这项横断面研究调查了白色和黑人癌症手术患者死亡率随时间的变化。
What are the disparities in mortality after cancer surgery between Black and White patients from 2007 to 2016? In this cross-sectional study of 870 929 cancer operations over 10 years, overall mortality rates after cancer surgery decreased for both Black and White patients; however, no significant narrowing of the mortality gap between Black and White patients was observed. Mortality improvements were largely associated with within-hospital factors. Overall, mortality rates following cancer surgery appear to be improving for both Black and White patients, but the gap in cancer surgery mortality rates between Black and White patients remains and does not appear to be narrowing. Racial disparities are well documented in cancer care. Overall, in the US, Black patients historically have higher rates of mortality after surgery than White patients. However, it is unknown whether racial disparities in mortality after cancer surgery have changed over time. To examine whether and how disparities in mortality after cancer surgery have changed over 10 years for Black and White patients overall and for 9 specific cancers. In this cross-sectional study, national Medicare data were used to examine the 10-year (January 1, 2007, to November 30, 2016) changes in postoperative mortality rates in Black and White patients. Data analysis was performed from August 6 to December 31, 2019. Participants included fee-for-service beneficiaries enrolled in Medicare Part A who had a major surgical resection for 9 common types of cancer surgery: colorectal, bladder, esophageal, kidney, liver, ovarian, pancreatic, lung, or prostate cancer. Cancer surgery among Black and White patients. Risk-adjusted 30-day, all-cause, postoperative mortality overall and for 9 specific types of cancer surgery. A total of 870 929 cancer operations were performed during the 10-year study period. In the baseline year, a total of 103 446 patients had cancer operations (96 210 White patients and 7236 Black patients). Black patients were slightly younger (mean [SD] age, 73.0 [6.4] vs 74.5 [6.8] years), and there were fewer Black vs White men (3986 [55.1%] vs 55 527 [57.7%]). Overall national mortality rates following cancer surgery were lower for both Black (−0.12%; 95% CI, −0.17% to −0.06% per year) and White (−0.14%; 95% CI, −0.16% to −0.13% per year) patients. These reductions were predominantly attributable to within-hospital mortality improvements (Black patients: 0.10% annually; 95% CI, −0.15% to −0.05%; P < .001; White patients: 0.13%; 95% CI, −0.14% to −0.11%; P < .001) vs between-hospital mortality improvements. Across the 9 different cancer surgery procedures, there was no significant difference in mortality changes between Black and White patients during the period under study (eg, prostate cancer: 0.35; 95% CI, 0.02-0.68; lung cancer: 0.61; 95% CI, −0.21 to 1.44). These findings offer mixed news for policy makers regarding possible reductions in racial disparities following cancer surgery. Although postoperative cancer surgery mortality rates improved for both Black and White patients, there did not appear to be any narrowing of the mortality gap between Black and White patients overall or across individual cancer surgery procedures. This cross-sectional study examines changes in mortality rates over time in White and Black patients undergoing surgery for cancer.
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影响因子：
3
作者：
Fong ZV;Chang DC;Hur C;Jin G;Tramontano A;Sell NM;Warshaw AL;Fernandez-Del Castillo C;Ferrone CR;Lillemoe KD;Qadan M
通讯作者：
Qadan M
影响因子：
4.7
作者：
Bristow, Robert E.;Zahurak, Marianna L.;Ibeanu, Okechukwu A.
通讯作者：
Ibeanu, Okechukwu A.
DOI：
10.1164/rccm.200808-1342oc
发表时间：
2009-03-01
影响因子：
24.7
作者：
Kates, Max;Perez, Xavier;Wisnivesky, Juan P.
通讯作者：
Wisnivesky, Juan P.
DOI：
10.1097/igc.0000000000000324
发表时间：
2015-01-01
影响因子：
4.8
作者：
Mahdi, Haider;Jernigan, Amelia;Rose, Peter G.
通讯作者：
Rose, Peter G.
影响因子：
2.6
作者：
Blumenthal, Daniel;Jena, Anupam B.
通讯作者：
Jena, Anupam B.