Racial and Ethnic Disparities in Cancer Survival: The Contribution of Tumor, Sociodemographic, Institutional, and Neighborhood Characteristics
Racial and Ethnic Disparities in Cancer Survival: The Contribution of Tumor, Sociodemographic, Institutional, and Neighborhood Characteristics
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DOI：
10.1200/jco.2017.74.2049
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发表时间：
2018-01-01
影响因子：
45.3
通讯作者：
Gomez, Scarlett Lin
中科院分区：
文献类型：
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作者：
Ellis, Libby;Canchola, Alison J.;Gomez, Scarlett Lin
目的在美国，癌症存活率的种族/种族差异已经有了很好的记录，但潜在的原因还没有被很好地理解。我们量化了肿瘤、治疗、医院、社会人口学和邻里因素对加州种族/民族生存差异的贡献。材料和方法使用加州癌症登记数据来估计2000至2013年间每个种族/民族(非西班牙裔黑人、西班牙裔、亚裔美国人和太平洋岛民，以及中国人、日本人和菲律宾人各不相同)与非西班牙裔白人相比，被诊断为乳腺癌、前列腺癌、结直肠癌或肺癌患者的基于人群的特定癌症生存率。结果在基线模型中，与白人相比，黑人患者的存活率最低，亚裔美国人和太平洋岛民的存活率最高。调解分析表明，诊断阶段对总体种族/民族生存差异的影响最大，占乳腺癌差异的24%，前列腺癌的24%，结直肠癌的16%至30%。社区的社会经济地位是所有癌症的重要因素，但仅限于黑人和西班牙裔患者。婚姻状况对种族/民族差异的影响男性强于女性。对所有协变量的调整解释了乳腺癌、前列腺癌和结直肠癌总体生存差异的大约一半，但它只解释了肺癌患者15%到40%的差异。结论与白人患者相比，种族/民族生存差异的总体减少主要是由黑人患者减少推动的。诊断阶段对种族/民族生存差异的影响最大，但及早发现并不能完全消除这些差异。社区社会经济状况和婚姻状况的影响表明，社会决定因素、支持机制和获得医疗保健的机会是重要的促成因素。(C)2017年美国临床肿瘤学会
PurposeRacial/ethnic disparities in cancer survival in the United States are well documented, but the underlying causes are not well understood. We quantified the contribution of tumor, treatment, hospital, sociodemographic, and neighborhood factors to racial/ethnic survival disparities in California.Materials and MethodsCalifornia Cancer Registry data were used to estimate population-based cancer-specific survival for patients diagnosed with breast, prostate, colorectal, or lung cancer between 2000 and 2013 for each racial/ethnic group (non-Hispanic black, Hispanic, Asian American and Pacific Islander, and separately each for Chinese, Japanese, and Filipino) compared with non-Hispanic whites. The percentage contribution of factors to overall racial/ethnic survival disparities was estimated from a sequence of multivariable Cox proportional hazards models.ResultsIn baseline models, black patients had the lowest survival for all cancer sites, and Asian American and Pacific Islander patients had the highest, compared with whites. Mediation analyses suggested that stage at diagnosis had the greatest influence on overall racial/ethnic survival disparities accounting for 24% of disparities in breast cancer, 24% in prostate cancer, and 16% to 30% in colorectal cancer. Neighborhood socioeconomic status was an important factor in all cancers, but only for black and Hispanic patients. The influence of marital status on racial/ethnic disparities was stronger in men than in women. Adjustment for all covariables explained approximately half of the overall survival disparities in breast, prostate, and colorectal cancer, but it explained only 15% to 40% of disparities in lung cancer.ConclusionOverall reductions in racial/ethnic survival disparities were driven largely by reductions for black compared with white patients. Stage at diagnosis had the largest effect on racial/ethnic survival disparities, but earlier detection would not entirely eliminate them. The influences of neighborhood socioeconomic status and marital status suggest that social determinants, support mechanisms, and access to health care are important contributing factors. (c) 2017 by American Society of Clinical Oncology