Racial disparities in the treatment of advanced epithelial ovarian cancer.
Racial disparities in the treatment of advanced epithelial ovarian cancer.
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DOI：
10.1097/aog.0b013e3182a92011
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发表时间：
2013-11
影响因子：
7.2
通讯作者：
Bickell N
中科院分区：
文献类型：
--
作者：
Howell EA;Egorova N;Hayes MP;Wisnivesky J;Franco R;Bickell N
研究指南推荐的治疗（手术和化疗）是否与晚期上皮性卵巢癌黑人和白色女性的死亡率差异相关。我们使用1995-2007年与医疗保险索赔相关的监测、流行病学和最终结果（SEER）进行了一项观察性队列研究。我们用Kaplan-Meier分析和考克斯回归分析评估了4,695例患有III期或IV期上皮性卵巢癌的黑人和白色女性的长期生存率，然后在通过倾向评分匹配的患者中创建两个相似的队列进行比较。我们调查了接受指南推荐的治疗和接受不完全治疗的妇女的种族、分期和生存率之间的关系。患有晚期上皮性卵巢癌的黑人女性比白色女性更容易死亡;未校正的风险比（HR）：1.27（95%置信区间[CI]：1.10-1.46）。黑人女性比白色女性更不可能接受指南推荐的治疗（54%对68%，p<0.001），未接受推荐治疗的女性的生存率低于接受推荐治疗的女性。考克斯比例风险模型显示，在接受指南推荐治疗的女性中，黑人与白色女性的死亡率无差异;校正HR：1.04（95% CI：0.85-1.26）或在接受不完全治疗的女性中;校正HR：1.09（95% CI：0.89-1.34）。通过倾向评分匹配的患者的生存分析证实了这些分析。指南推荐治疗率的差异与晚期上皮性卵巢癌妇女中黑人和白人死亡率的差异有关。
To examine whether treatment with guideline-recommended care (surgery and chemotherapy) is associated with mortality differences between black and white women with advanced epithelial ovarian cancer. We conducted an observational cohort study using the Surveillance, Epidemiology, and End Results (SEER) linked to Medicare claims for 1995-2007. We evaluated long-term survival for 4,695 black and white women with stage III or IV epithelial ovarian cancer with Kaplan-Meier analysis and Cox regression, and then in patients matched by propensity score to create two similar cohorts for comparison. We investigated the association between race, stage, and survival among women who were treated with guideline-recommended care and those who received incomplete treatment. Black women with advanced epithelial ovarian cancer were more likely to die than white women; unadjusted hazard ratio (HR):1.27 (95% confidence interval [CI]: 1.10-1.46). Black women were less likely than white women to receive guideline-recommended care (54% vs. 68%, p<0.001) and women who did not receive recommended treatment had lower survival than women who received recommended care. Cox proportional hazards models demonstrated no black versus white differences in mortality among women who were treated with guideline-recommended care; adjusted HR:1.04 (95% CI: 0.85-1.26) or among women who received incomplete treatment; adjusted HR:1.09 (95% CI: 0.89-1.34). The survival analysis of patients matched by propensity score confirmed these analyses. Differences in rates of treatment with guideline-recommended care are associated with black–white mortality disparities among women with advanced epithelial ovarian cancer.