Esophageal Cancer Presentation, Treatment, and Outcomes Vary With Hospital Safety-Net Burden
Esophageal Cancer Presentation, Treatment, and Outcomes Vary With Hospital Safety-Net Burden
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DOI：
10.1016/j.athoracsur.2018.11.065
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发表时间：
2019-05-01
影响因子：
4.6
通讯作者：
Litle, Virginia R.
中科院分区：
文献类型：
--
作者：
Sridhar, Praveen;Bhatt, Maunil;Litle, Virginia R.
背景健康的社会决定因素影响食管癌患者的诊断和护理。本研究假设医院安全网负担影响食管癌患者的就诊、治疗和预后。在国家癌症数据库中查询食管癌患者（2004年至2013年）。治疗设施根据其未投保或医疗补助保险患者的相对负担进行分类。采用卡方分析、KaplanMeier生存分析和多变量模型比较低（LBH）、中（MBH）和高（HBH）安全网负担医院的患者人口统计学资料、疾病和治疗特征以及生存率。共有来自1，215个设施的56，115名患者。HBH治疗了更大比例的种族和少数民族以及社会经济地位较低的患者。HBH的患者出现在晚期，接受初次手术治疗的频率低于MBH和LBH。调整年龄、性别、人种、种族、收入、合并症、分期、组织学类型、肿瘤位置、设施类型、保险状况和治疗方式后，HBH和LBH之间食管腺癌患者的生存率无显著差异（风险比，1.06; 95%置信区间，0.99至1.14; p = 0.093）。对于鳞状细胞癌患者，HBH与比LBH更高的死亡风险相关（危害比，1.11; 95%可信区间，1.02 ~ 1.20; p = 0.014）。与LBH相比，HBH对鳞状细胞癌患者有死亡风险，但对腺癌无死亡风险。应在安全网医院中进一步分析未调整的变量，如体能状态、治疗完成情况和护理的连续性等，以建立适当的临床路径，为弱势人群的食管癌提供护理。(C)2019年美国胸外科医师协会
Background. Social determinants of health affect diagnosis and delivery of care to patients with esophageal cancer. This study hypothesized that hospital safety-net burden affects presentation, treatment, and outcomes in patients with esophageal cancer.Methods. The National Cancer Database was queried for patients with esophageal cancer (2004 to 2013). Treating facilities were categorized according to their relative burden of uninsured or Medicaid-insured patients. Hospitals with low (LBH), medium (MBH), and high (HBH) safety-net burden were compared with respect to patient demographics, disease and treatment characteristics, and survival using chi(2) analysis, KaplanMeier survival analysis, and multivariable modeling.Results. There were 56,115 patients from 1,215 facilities. HBH treated a greater proportion of racial and ethnic minorities and patients with lower socioeconomic status. Patients at HBH presented at later stages and received primary surgical therapy less often than at MBH and LBH. Survival for patients with esophageal adenocarcinoma did not differ significantly between HBH and LBH after adjusting for age, sex, race, ethnicity, income, comorbidity, stage, histologic type, tumor location, facility type, insurance status, and treatment modality (hazard ratio, 1.06; 95% confidence interval, 0.99 to 1.14; p = 0.093). HBH were associated with a higher mortality risk than LBH for patients with squamous cell carcinoma (hazard ratio, 1.11; 95% confidence interval, 1.02 to 1.20; p = 0.014).Conclusions. There is a mortality risk for patients with squamous cell carcinoma, but not for adenocarcinoma at HBH compared with LBH. Further analysis of unadjusted variables such as performance status, completion of therapy, and continuity of care, and others should be undertaken among safety-net hospitals with the goal of creating appropriate clinical pathways for care of esophageal cancer in vulnerable populations. (C) 2019 by The Society of Thoracic Surgeons