Disparities in Prostate, Lung, Breast, and Colorectal Cancer Survival and Comorbidity Status among Urban American Indians and Alaskan Natives.
Disparities in Prostate, Lung, Breast, and Colorectal Cancer Survival and Comorbidity Status among Urban American Indians and Alaskan Natives.
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DOI：
10.1158/0008-5472.can-17-0429
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发表时间：
2017-12-01
期刊：
影响因子：
11.2
通讯作者：
Habel LA
中科院分区：
文献类型：
--
作者：
Emerson MA;Banegas MP;Chawla N;Achacoso N;Alexeeff SE;Adams AS;Habel LA
癌症是美洲印第安人和阿拉斯加原住民(AIAN)的第二大死因；尽管这一人群的癌症生存信息有限，特别是在城市AIAN中。在这项回顾性队列研究中，我们比较了AIAN(n=582)和非西班牙裔白人(Nhw)(n=82,696)在1997-2015年间被诊断为原发浸润性乳腺癌、前列腺癌、肺癌或结直肠癌的北加州凯撒永久医院(KPNC)的全原因死亡率和前列腺癌、乳腺癌、肺癌和结直肠癌特异性死亡率。肿瘤登记和其他电子健康记录提供了有关社会人口学、合并症、肿瘤、临床和治疗特征的信息。用Cox回归模型估计调整后的生存曲线和危险比(HR)，可信区间(CI)为95%。AIAN患者的共病负担显著高于NHW患者(P<；0.05)。在调整了患者、疾病特征和Charlson共病评分后，AIAN患者的全因死亡率和肿瘤特异性死亡率显著高于NHW乳腺癌患者(HR=1.47，95%CI：1.13，1.92)或前列腺癌患者(HR=1.87，95%CI：1.14，3.06)，但AIAN患者并不包括肺癌和结直肠癌。尽管在这种情况下，AIAN患者获得预防服务和癌症护理的机会大致相同，但我们发现AIAN患者在某些癌症中的死亡率高于NHW患者，并且AIAN癌症患者合并多种疾病的比例更高。这项研究提供了关于居住在城市地区的71%的美国印第安人/阿拉斯加原住民的癌症经历的迫切需要的信息，他们获得了印度医疗服务以外的癌症护理，AIAN癌症信息的绝大多数来自印度医疗服务。
Cancer is the second leading cause of death among American Indians and Alaskan Natives (AIAN); although cancer survival information in this population is limited, particularly among urban AIAN. In this retrospective cohort study, we compared all-cause and prostate, breast, lung, and colorectal cancer-specific mortality among AIAN (n=582) and non-Hispanic Whites (NHW) (n=82,696) enrollees of Kaiser Permanente Northern California (KPNC) diagnosed with primary invasive breast, prostate, lung, or colorectal cancer from 1997–2015. Tumor registry and other electronic health records provided information on sociodemographic, comorbidities, tumor, clinical, and treatment characteristics. Cox regression models were used to estimate adjusted survival curves and hazard ratios (HR) with 95% confidence intervals (CI). AIAN had a significantly higher comorbidity burden compared to NHW (p < 0.05). When adjusting for patient, disease characteristics and Charlson comorbidity scores, all-cause mortality and cancer-specific mortality were significantly higher for AIAN than NHW patients with breast cancer (HR= 1.47, 95% CI: 1.13, 1.92) or with prostate cancer (HR = 1.87, 95% CI: 1.14, 3.06) but not for AIAN patients with lung and colorectal cancer. Despite approximately equal access to preventive services and cancer care in this setting, we found higher mortality for AIAN than NHW with some cancers, and a greater proportion of AIAN cancer patients with multiple comorbid conditions. This study provides severely needed information on the cancer experience of the 71% of American Indians/Alaskan Natives who live in urban areas and access cancer care outside of the Indian Health Services, from which the vast majority of AIAN cancer information comes.