Underuse of surgical resection for localized, non-small cell lung cancer among whites and African Americans in South Carolina
Underuse of surgical resection for localized, non-small cell lung cancer among whites and African Americans in South Carolina
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DOI：
10.1016/j.athoracsur.2008.02.072
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发表时间：
2008-07-01
影响因子：
4.6
通讯作者：
Ford, Marvella E.
中科院分区：
文献类型：
--
作者：
Esnaola, Nestor F.;Gebregziabher, Mulugeta;Ford, Marvella E.
背景早期使用医疗保险数据的研究报告了局部非小细胞肺癌手术治疗的种族差异。我们分析了种族对近期以人群为基础的局部非小细胞肺癌患者手术切除的独立影响，控制了合并症和社会经济状况。1996年至2002年期间向我们州癌症登记处报告的所有局部非小细胞肺癌病例都得到了确认，并与住院/门诊手术文件和2000年人口普查相关联。使用管理数据代码计算科摩罗指数（Romano-Charlson指数）。教育水平和收入是根据人口普查数据估算的。使用卡方检验比较了白色和非裔美国人患者的特征。采用Logistic回归分析计算切除的优势比和95%可信区间。我们确定了2,506名白色和550名非洲裔美国人患者。非裔美国人更可能是年轻，男性，未婚，受教育程度较低，贫穷，没有保险或医疗补助（所有p < 0.0001），并居住在农村社区（p = 0.0005）。不同种族之间手术切除的使用率低于之前的报道，非裔美国人接受手术的可能性明显低于白人（44.7%比63.4%; p < 0.0001）。即使在控制了社会人口统计学、合并症和肿瘤因素后，非裔美国人切除的调整优势比为0.43（95%置信区间为0.34 - 0.55）。局部非小细胞肺癌手术切除的使用不足是一个持续存在的问题，特别是在非洲裔美国人中。迫切需要进一步的研究来确定这些观察结果背后的患者，医生和卫生系统相关因素，并优化非小细胞肺癌的切除率。
Background. Early studies using Medicare data reported racial disparities in surgical treatment of localized, non-small cell lung cancer. We analyzed the independent effect of race on use of surgical resection in a recent, population-based sample of patients with localized non-small cell lung cancer, controlling for comorbidity and socioeconomic status.Methods. All cases of localized non-small cell lung cancer reported to our state Cancer Registry between 1996 and 2002 were identified and linked to the Inpatient/Outpatient Surgery Files and 2000 Census. Comorbidity (Romano-Charlson index) was calculated using administrative data codes. Educational level and income were estimated using census data. Characteristics of white and African American patients were compared using chi(2) tests. Odds ratios of resection and 95% confidence intervals were calculated using logistic regression.Results. We identified 2,506 white and 550 African American patients. African Americans were more likely to be younger, male, not married, less educated, poor, and uninsured or covered by Medicaid (all p < 0.0001), and to reside in rural communities (p = 0.0005). Use of surgical resection across races was lower than previously reported, and African Americans were significantly less likely to undergo surgery compared with whites (44.7% versus 63.4%; p < 0.0001). Even after controlling for sociodemographics, comorbidity, and tumor factors, the adjusted odds ratio for resection for African Americans was 0.43 (95% confidence interval, 0.34 to 0.55).Conclusions. Underuse of surgical resection for localized, non-small cell lung cancer is a persistent problem, particularly among African Americans. Further studies are urgently needed to identify the patient-, physician-, and health system-related factors underlying these observations and optimize resection rates for non-small cell lung cancer.