Getting back to equal: The influence of insurance status on racial disparities in the treatment of African American men with high-risk
Getting back to equal: The influence of insurance status on racial disparities in the treatment of African American men with high-risk
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DOI：
10.1016/j.urolonc.2014.04.014
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发表时间：
2014-11-01
影响因子：
2.7
通讯作者：
Nguyen, Paul L.
中科院分区：
文献类型：
--
作者：
Mahal, Brandon A.;Ziehr, David R.;Nguyen, Paul L.
目的：对高危前列腺癌(CAP)进行明确的治疗可提高存活率。我们评估了拥有医疗保险是否减少了在使用明确的高危CAP治疗方面的种族差异。材料和方法：监测、流行病学和最终结果计划被用来识别从2007年到2010年确诊的70,006名患有局限性高危CAP(前列腺特异性抗原水平20 ng/ml或Gleason评分8-10或分期>；cT3a)的男性。结果：与白人男性相比，非洲裔美国人(AA)男性接受明确治疗的可能性显著低于白人男性(调整后的优势比=0.6；95%，CI：0.56~0.64；P<；0.001)。种族和保险状况之间存在显著的交互作用(P-交互作用=0.01)，因此保险覆盖范围与再生障碍性贫血患者和白人患者在接受明确治疗方面的种族差异缩小有关。具体来说，在未参保的男性中，再生障碍性贫血与白人最终治疗的比值比为0.38(95%CI：0.27-0.54，P<；0.001)，而在保险男性中，这一比值比为0.62(95%CI：0.57-0.66，P<；0.001)。结论：与白人男性相比，具有高风险帽的再障男性接受潜在救命最终治疗的可能性显著降低。拥有医疗保险与减少这种种族待遇差异有关，这表明扩大医疗保险覆盖范围可能有助于减少在管理侵袭性癌症方面的种族差异。(C)2014 Elsevier Inc.保留所有权利。
Objectives: Treating high-risk prostate cancer (CaP) with definitive therapy improves survival. We evaluated whether having health insurance reduces racial disparities in the use of definitive therapy for high-risk CaP.Materials and methods: The Surveillance, Epidemiology, and End Results Program was used to identify 70,006 men with localized high-risk CaP (prostate-specific antigen level > 20 ng/ml or Gleason score 8-10 or stage > cT3a) diagnosed from 2007 to 2010. We used multivariable logistic regression to analyze the 64,277 patients with complete data to determine the factors associated with receipt of definitive therapy.Results: Compared with white men, African American (AA) men were significantly less likely to receive definitive treatment (adjusted odds ratio [AOR] = 0.60; 95%.CI: 0.56-0.64; P < 0.001) after adjusting for sociodemographics and known CaP prognostic factors. There was a significant interaction between race and insurance status (P-interaction = 0.01) such that insurance coverage was associated with a reduction in racial disparity between AA and white patients regarding receipt of definitive therapy. Specifically, the AOR for definitive treatment for AA vs. white was 0.38 (95% CI: 0.27-0.54, P < 0.001) among uninsured men, whereas the AOR was 0.62 (95% CI: 0.57-0.66, P < 0.001) among insured men.Conclusions: AA men with high-risk CaP were significantly less likely to receive potentially life-saving definitive treatment when compared with white men. Having health insurance was associated with a reduction in this racial treatment disparity, suggesting that expansion of health insurance coverage may help reduce racial disparities in the management of aggressive cancers. (C) 2014 Elsevier Inc. All rights reserved.