Effect of Hospital Safety Net Designation on Treatment Use and Survival in Hepatocellular Carcinoma
Effect of Hospital Safety Net Designation on Treatment Use and Survival in Hepatocellular Carcinoma
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DOI：
10.1002/cncr.31066
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发表时间：
2018-02-15
期刊：
影响因子：
6.2
通讯作者：
Yopp, Adam C.
中科院分区：
文献类型：
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作者：
Mokdad, Ali A.;Murphy, Caitlin C.;Yopp, Adam C.
背景：少数种族/民族肝细胞癌（HCC）患者的生存率低于非西班牙裔白人。比较不同卫生保健系统的患者结果可以确定造成这种差异的生物和保健提供机制。我们比较了在安全网医院（snh）和非snh治疗的HCC患者的表现、治疗和生存率。方法：2001年至2012年诊断为HCC的患者在德克萨斯州癌症登记处被确定。我们比较了三种医院类别的医院和患者特征：非SNHs、低比例SNHs （l-SNHs）和高比例SNHs （h-SNHs）。比较三种医院类别间经协变量调整的治疗使用和总生存期。结果：尽管仅包括23%的医院，h- snh治疗了17489例HCC患者中的42%，并且与非snh相比，不成比例地为种族/少数民族和低社会经济地位的患者提供护理。与非snhs相比，l-SNHs的治疗使用相似（45% vs 45%；调整优势比[OR]， 0.97； 95%可信区间[CI]， 0.89-1.06），但h-SNHs的治疗使用明显较低（32% vs 45%； OR, 0.64; 95% CI, 0.57-0.73）。同样，局限性HCC患者在h- snh接受根治性治疗的可能性低于非snh （OR, 0.51; 95% CI, 0.40-0.66）。与非snhs患者相比，l-SNHs患者的总生存率相似（风险比[HR]， 0.93; 95% CI, 0.89-0.98），但h-SNHs患者的总生存率明显差（风险比，1.30;95% CI, 1.22-1.39）。结论：snh患者接受HCC治疗的可能性较低，即使在早期诊断，这可能导致较差的生存率。系统层面的医疗服务差异可能部分解释了HCC预后的种族/民族和社会经济差异。(C) 2017美国癌症协会。
BACKGROUND: Racial/ethnic minorities with hepatocellular carcinoma (HCC) have worse survival than non-Hispanic whites. Comparing patient outcomes across health care delivery systems can identify biological and care delivery mechanisms contributing to this disparity. We compared presentation, treatment, and survival of HCC patients treated at safety net hospitals (SNHs) and non-SNHs. METHODS: Patients diagnosed with HCC from 2001 to 2012 were identified in the Texas Cancer Registry. We compared hospital and patient characteristics across three hospital categories: non-SNHs, low-proportion SNHs (l-SNHs), and high-proportion SNHs (h-SNHs). Covariate-adjusted treatment use and overall survival were compared among the 3 hospital categories. RESULTS: Despite comprising only 23% of hospitals, h-SNHs cared for 42% of 17,489 HCC patients and disproportionately delivered care to racial/ethnic minorities and patients of low socioeconomic status compared with non-SNHs. Compared with non-SNHs, treatment use was similar at l-SNHs (45% vs 45%; adjusted odds ratio [OR], 0.97; 95% confidence interval [CI], 0.89-1.06) but significantly lower at h-SNHs (32% vs 45%; OR, 0.64; 95% CI, 0.57-0.73). Similarly, patients with localized HCC were less likely to undergo curative treatment at h-SNHs than non-SNHs (OR, 0.51; 95% CI, 0.40-0.66). Compared with non-SNHs, overall survival was similar at l-SNHs (hazard ratio [HR], 0.93; 95% CI, 0.89-0.98) but significantly worse at h-SNHs (HR, 1.30; 95% CI, 1.22-1.39). CONCLUSION: Patients at SNHs are less likely to undergo HCC treatment, even when diagnosed at an early stage, which likely contributes to worse survival. System-level differences in care delivery may partly explain racial/ethnic and socioeconomic disparities in HCC prognosis. (C) 2017 American Cancer Society.