Mediation analyses of socioeconomic factors determining racial differences in the treatment of diffuse large B-cell lymphoma in a cohort of older adults
Mediation analyses of socioeconomic factors determining racial differences in the treatment of diffuse large B-cell lymphoma in a cohort of older adults
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DOI：
10.1097/md.0000000000017960
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发表时间：
2019-11-01
期刊：
影响因子：
1.6
通讯作者：
Calip, Gregory S.
中科院分区：
文献类型：
--
作者：
Guadamuz, Jenny S.;Ozenberger, Katharine;Calip, Gregory S.
尽管医疗保险几乎实现了全民健康覆盖，但美国老年患者中弥漫性大B细胞淋巴瘤（DLBCL）的治疗仍然存在种族差异。评估DLBCL结果的研究通常将社会经济地位（SES）指标作为混杂因素，当SES因素是癌症治疗差异的中介时，可能会引入偏倚。和私人医疗保险补充使用监测，流行病学和最终结果-医疗保险链接数据库在2001年和2011年之间。在年龄66岁以上的DLBCL患者的这项回顾性队列研究中，我们进行了一系列多变量逻辑回归分析，估计与化疗和/或免疫疗法治疗和每个SES测量相关的比值比（OR）和95%置信区间（CI），将非西班牙裔（NH）黑人、西班牙裔/拉丁裔和亚洲/太平洋岛民（API）与NH白人患者进行比较。种族/少数民族患者接受化疗和/或免疫治疗的几率较低（NH-黑人：OR 0.84，95% CI 0.65，1.08; API：OR 0.80，95% CI 0.64，1.01;西班牙裔/拉丁裔：OR 0.78，95% CI 0.64，0.96），缺乏私人医疗保险补充和居住在城市MSA和贫困人口普查区的几率更高。调整SES措施作为混杂因素，使观察到的种族差异无效。在因果中介分析中，31%至38%的种族/民族差异是由私人医疗保险补充介导的。提供公平的医疗保险补充可能会减少老年DLBCL患者接受化疗和/或免疫治疗的差异。
Despite near universal health coverage under Medicare, racial disparities persist in the treatment of diffuse large B-cell lymphoma (DLBCL) among older patients in the United States. Studies evaluating DLBCL outcomes often treat socioeconomic status (SES) measures as confounders, potentially introducing biases when SES factors are mediators of disparities in cancer treatment.To examine differences in DLBCL treatment, we performed causal mediation analyses of SES measures, including: metropolitan statistical area (MSA) of residence; census-tract poverty level; and private Medicare supplementation using the Surveillance, Epidemiology and End Results-Medicare linked database between 2001 and 2011. In this retrospective cohort study of DLBCL patients ages 66+ years, we conducted a series of multivariable logistic regression analyses estimating odds ratios (OR) and 95% confidence intervals (CI) relating chemo- and/or immuno-therapy treatment and each SES measure, comparing non-Hispanic (NH)-black, Hispanic/Latino, and Asian/Pacific Islander (API) to NH-white patients.Compared to NH-white patients, racial/ethnic minority patients had lower odds of receiving chemo- and/or immuno-therapy treatment (NH-black: OR 0.84, 95% CI 0.65, 1.08; API: OR 0.80, 95% CI 0.64, 1.01; Hispanic/Latino: OR 0.78, 95% CI 0.64, 0.96) and higher odds of lacking private Medicare supplementation and residence within an urban MSA and poor census tracts. Adjustment for SES measures as confounders nullified observed racial differences. In causal mediation analyses, between 31% and 38% of race/ethnicity differences were mediated by having private Medicare supplementation.Providing equitable access to Medicare supplementation may reduce disparities in receipt of chemo- and/or immuno-therapy treatment in older DLBCL patients.