Racial disparities in diagnostic evaluation of uterine cancer among Medicaid beneficiaries.
Racial disparities in diagnostic evaluation of uterine cancer among Medicaid beneficiaries.
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医疗补助受益人子宫癌诊断评估中的种族差异。
DOI：
10.1093/jnci/djad027
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Wright,JasonD
中科院分区：
文献类型：
--
作者：
Xu,Xiao;Chen,Ling;Nunez-Smith,Marcella;Clark,Mitchell;Wright,JasonD
为了揭示导致子宫癌早期诊断中黑白差异的原因，我们比较了黑人和白人异常子宫出血患者接受的诊断评估的质量，最终诊断为子宫癌。方法利用2008-2019年MarketScan多州医疗补助数据库，我们确定了表现为异常子宫出血的黑人(n = 858)和白人(n = 1749)子宫癌患者。诊断评估的质量通过以下几个方面进行衡量：延迟诊断(报告非淋巴报告后1 ；年)、未接受指南推荐的诊断程序、首次诊断程序的延迟时间(报告非淋巴报告后2 月)、已接受诊断程序的次数以及评估和管理就诊的次数。结果黑人患者比白人患者更容易经历延迟诊断(11.3%比8.3%，P= .01；调整后的优势比[OR] = 1.71，95%可信区间[CI] = 1.27至2.29)或不接受指南推荐的诊断程序(10.1%比5.0%，P<； .001；调整后的OR = 1.94，95%CI = 1.40至2.68)。即使接受了推荐的诊断程序，黑人患者也比白人患者更有可能经历第一次诊断程序的延迟(调整后的OR = 为1.46，95%CI = 为1.09至1.97)。此外，黑人子宫癌患者在确诊前接受了更多的非淋巴评估和管理访问(调整后的平均 = 为1.13，95%CI = 为1.04~1.23)。改善这一领域的公平性可能有助于缩小诊断阶段的黑白差距。
BackgroundTo inform reasons contributing to Black-White disparity in early diagnosis of uterine cancer, we compared the quality of diagnostic evaluation received by Black vs White patients with abnormal uterine bleeding (AUB) ultimately diagnosed with uterine cancer.MethodsUsing 2008-2019 MarketScan Multi-State Medicaid Database, we identified Black (n = 858) and White (n = 1749) patients with uterine cancer presenting with AUB. Quality of diagnostic evaluation was measured by delayed diagnosis (>1 year after AUB reporting), not receiving guideline-recommended diagnostic procedures, delayed time to first diagnostic procedure (>2 months after AUB reporting), number of diagnostic procedures received, and number of evaluation and management visits for AUB. The association between race and quality indicators was examined by multivariable regressions adjusting for patient characteristics.ResultsBlack patients were more likely than White patients to experience delayed diagnosis (11.3% vs 8.3%,P= .01; adjusted odds ratio [OR] = 1.71, 95% confidence interval [CI] = 1.27 to 2.29) or to not receive guideline-recommended diagnostic procedures (10.1% vs 5.0%,P< .001; adjusted OR = 1.94, 95% CI = 1.40 to 2.68). Even when they did receive recommended diagnostic procedures, Black patients were more likely than White patients to experience delay in time to the first diagnostic procedure (adjusted OR = 1.46, 95% CI = 1.09 to 1.97). In addition, Black patients underwent more evaluation and management visits for AUB before getting diagnosed compared with White patients (adjusted mean ratio = 1.13, 95% CI = 1.04 to 1.23).ConclusionsBlack and White patients with uterine cancer differed in the quality of diagnostic evaluation received. Improving equity in this area may help reduce Black-White disparity in stage at diagnosis.
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