Racial/Ethnic Disparity in Treatment for Prostate Cancer: Does Cancer Severity Matter?
Racial/Ethnic Disparity in Treatment for Prostate Cancer: Does Cancer Severity Matter?
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DOI：
10.1016/j.urology.2016.07.045
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发表时间：
2017-01-01
期刊：
影响因子：
2.1
通讯作者：
Underwood, Willie, III
中科院分区：
文献类型：
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作者：
Moses, Kelvin A.;Orom, Heather;Underwood, Willie, III
目的：确定不同种族和疾病严重程度的患者接受治疗是否存在差异。在美国，不同种族的前列腺癌（PCa）患者的治疗存在差异，这可能是结果潜在差异的来源。方法利用监测、流行病学和最终结果17，我们从2004年到2011年确定了327,636名诊断为PCa的男性。进行Logistic回归分析以确定在疾病严重程度的背景下接受最终治疗与种族的关联。结果：非裔美国人（AA）和西班牙裔男性接受治疗的可能性低于白人男性（优势比[OR] 0.73, 95%可信区间[CI] 0.71, 0.75， OR分别为0.95,95% CI 0.92, 0.98）。与白人男性相比，AA男性在每个D'Amico风险分类中接受最终治疗的OR显著降低，每增加一个风险类别，治疗的几率都在降低（低风险OR 0.81, 95% CI 0.78, 0.85；中风险OR 0.74, 95% CI 0.71, 0.77；高风险OR 0.62, 95% CI 0.58, 0.66）。西班牙裔男性中危（OR 0.89, 95% CI 0.84, 0.94）或高危（OR 0.79, 95% CI 0.72, 0.85）患者接受治疗的几率低于白人男性。在任何Gleason或D'Amico分类中，亚洲男性接受治疗的几率与白人男性相似或更高。结论：与白人男性相比，AA和西班牙裔男性接受PCa治疗的比例存在显著差异。接受治疗的差异揭示了一个发展风险分层治疗方法的机会领域，而不考虑种族身份，这可能会解决这些人群中与pca相关的较差结果。(C) 2016 Elsevier Inc.
OBJECTIVE To determine if there are variations in the receipt of treatment based on race and disease severity. Treatment variations in men with prostate cancer (PCa) among the various racial groups in the United States exist, which may be a source of potential disparity in outcome.METHODS Utilizing Surveillance, Epidemiology and End Results 17, we identified 327,636 men diagnosed with PCa from 2004 to 2011. Logistic regression analysis was performed to determine the association of receiving definitive treatment and race in the context of disease severity.RESULTS African American (AA) and Hispanic men were less likely to receive treatment compared to White men (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.71, 0.75, and OR 0.95, 95% CI 0.92, 0.98, respectively). AA men had significantly lower OR of receiving definitive treatment within each D'Amico risk classification compared to White men, with decreasing odds of treatment for each increase in risk category (low-risk OR 0.81, 95% CI 0.78, 0.85; intermediaterisk OR 0.74, 95% CI 0.71, 0.77; and high-risk OR 0.62, 95% CI 0.58, 0.66). Hispanic men with intermediate-risk (OR 0.89, 95% CI 0.84, 0.94) or high-risk (OR 0.79, 95% CI 0.72, 0.85) disease had lower odds of receiving treatment compared to White men. Asian men had similar or greater odds of receiving treatment compared to White men within any Gleason or D'Amico classification.CONCLUSION There is a significant disparity in the receipt of treatment for PCa among AA and Hispanic men compared to White men. The variations in receipt of treatment reveal an area of opportunity to develop risk-stratified approaches to treatment regardless of ethnic identity, which may address the poorer PCa-related outcomes in these populations. (C) 2016 Elsevier Inc.