Racial disparities and colorectal cancer survival in older adults with and without diabetes mellitus.
Racial disparities and colorectal cancer survival in older adults with and without diabetes mellitus.
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DOI：
10.1111/jgh.12637
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发表时间：
2014-12
影响因子：
4.1
通讯作者：
Yeh HC
中科院分区：
文献类型：
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作者：
Waheed S;Azad N;Waheed S;Yeh HC
研究既存糖尿病是否会改变结直肠癌（CRC）生存率的种族差异。我们分析了来自监测流行病学和最终结果（SEER）-医疗保险数据库的16，977例CRC患者（年龄≥67岁）的前瞻性数据。SEER登记研究包括人口统计学、肿瘤特征和治疗方面的数据。医疗保险索赔被用来定义预先存在的糖尿病和共病条件。两个来源均证实了死亡率。在基线时，1，332（8%）是非洲裔美国人，26%患有糖尿病（黑人39%;白人25%）。从2000年到2005年，超过一半的参与者死亡（N= 8，782，52%）。这包括黑人中的820例（62%）死亡（每100人每年23.8例），白人中的7，962例（51%）死亡（每100人每年16.6例）。在老年糖尿病患者中，调整人口统计学特征后，黑人的全因死亡率和CRC死亡率风险显著更高[风险比（HR），95%置信区间（CI）分别为：1.21（1.08-1.37）和1.21（1.03-1.42）]，但在对癌症分期和分级进行额外调整后，这些相关性减弱为零。在无糖尿病的成人中，在包括人口统计学变量、癌症分期、分级、治疗和合并症的完全校正模型中，黑人的全因死亡风险[HR（95% CI）：1.14（1.04-1.25）]和CRC死亡风险[HR（95% CI）：1.21（1.08-1.36）]仍高于白人。在患有CRC的老年人中，糖尿病是种族和死亡率之间关系的影响因素。糖尿病患者的人口统计学、癌症分期和分级解释了生存率的种族差异。
To investigate whether pre-existing diabetes modifies racial disparities in colorectal cancer (CRC) survival. We analyzed prospective data from 16,977 patients (age≥67 years) with CRC from the Surveillance Epidemiology and End Results (SEER)-Medicare database. SEER registries included data on demographics, tumor characteristics, and treatment. Medicare claims were used to define pre-existing diabetes and comorbid conditions. Mortality was confirmed in both sources. At baseline, 1,332 (8%) were African-Americans and 26% had diabetes (39% in blacks; 25% in whites). From 2000 to 2005, more than half of the participants died (N=8,782, 52%). This included 820 (62%) deaths (23.8 per 100 per-years) among blacks, and 7,962 (51%) deaths (16.6 per 100 person-years) among whites. Among older adults with diabetes, blacks had significantly higher risk of all-cause and CRC mortality after adjustments for demographic characteristics, [hazard ratio (HR), 95% confidence interval (CI): 1.21 (1.08–1.37) and 1.21 (1.03–1.42)], respectively, but these associations attenuated to null after additional adjustments for cancer stage and grade. Among adults without diabetes, the risk of all-cause mortality [HR (95% CI): 1.14 (1.04–1.25)] and CRC mortality [HR (95% CI): 1.21 (1.08–1.36)] remained higher in blacks than whites in fully-adjusted models that included demographic variables, cancer stage, grade, treatments, and co-morbidities. Among older adults with CRC, diabetes is an effect modifier on the relationship between race and mortality. Racial disparities in survival were explained by demographics, cancer stage and grade in patients with diabetes.