Factor Analysis of Health Care Access With Ovarian Cancer Surgery and Gynecologic Oncologist Consultation.
Factor Analysis of Health Care Access With Ovarian Cancer Surgery and Gynecologic Oncologist Consultation.
复制标题
DOI：
10.1001/jamanetworkopen.2022.54595
复制
发表时间：
2023-02-01
影响因子：
13.8
通讯作者：
Akinyemiju TF
中科院分区：
文献类型：
--
作者：
Gupta A;Chen Q;Wilson LE;Huang B;Pisu M;Liang M;Previs RA;Moss HA;Ward KC;Schymura MJ;Berchuck A;Akinyemiju TF
在咨询妇科肿瘤医生和接受卵巢癌手术时，医疗保健的可负担性、可用性和可及性是否与种族和民族差异相关？在这项8987例患者的队列研究中，医疗服务的可用性和可负担性评分与妇科肿瘤医生咨询相关，而可负担性评分与手术接受相关。然而，非西班牙裔黑人患者不太可能比非西班牙裔白色患者咨询妇科肿瘤学家，并进行手术，即使在调整这些卫生保健访问因素。这些研究结果表明，负担能力和可用性显着相关的指标，遵循指南的护理，但并不能完全解释差异。这项队列研究评估了医疗保健的可负担性、可获得性和可及性沿着种族和种族与接受符合指南的卵巢癌治疗的相关性。较差的卫生保健获得（HCA）与卵巢癌（OC）生存的种族和民族差异有关。通过因子分析生成代表医疗保健可负担性、可用性和可及性的综合评分，并评估每个评分与遵循指南的护理的关键指标之间的关联。这项回顾性队列研究使用了2008年至2015年期间在监测，流行病学和最终结果（SEER）医疗保险数据库中诊断的OC患者的数据。SEER医疗保险数据库使用癌症登记数据和来自美国12个州的相关医疗保险索赔。纳入的患者为2008年至2015年诊断为任何组织学类型的首次或第二次原发性OC（国际肿瘤疾病分类，第3版[ICD-O-3]代码C569）的65岁或以上的西班牙裔、非西班牙裔黑人和非西班牙裔白色个体。数据分析时间为2020年6月至2022年6月。SEER医疗保险数据集与公开数据集相关联，以获得代表医疗保健负担能力，可用性和可及性的35个变量。使用验证性因素分析为每个维度创建综合评分，然后对多个组成变量进行promax（倾斜）旋转。主要结局是在诊断前2个月或诊断后6个月内与妇科肿瘤医生进行OC咨询和接受OC相关手术。该队列包括8987例患者，平均（SD）年龄为76.8（7.3）岁，612例黑人患者（6.8%）、553例西班牙裔患者（6.2%）和7822例白色患者（87.0%）。黑人患者（校正比值比[aOR]，0.75; 95% CI，0.62-0.91）和西班牙裔患者（aOR，0.81; 95%CI，0.67-0.99）与白色患者相比，不太可能咨询妇科肿瘤医生，在调整人口统计学和临床特征后，黑人患者不太可能接受手术（aOR，0.76; 95% CI，0.62-0.94）。HCA的可用性和可负担性均与妇科肿瘤医生咨询相关（可用性：aOR，1.16; 95%CI，1.09-1.24;可负担性：aOR，1.13; 95%CI，1.07-1.20），而可负担性与接受OC手术相关（aOR，1.08; 95%CI，1.01-1.15）。在针对可用性、可负担性和可及性相互调整的模型中，黑人患者仍然不太可能咨询妇科肿瘤医生（aOR，0.80; 95%CI，0.66-0.97）和接受手术（aOR，0.80; 95%CI，0.65-0.99）。在西班牙裔、非西班牙裔黑人和非西班牙裔白色OC患者的队列研究中，HCA的可负担性和可用性与接受手术和咨询妇科肿瘤学家显著相关。然而，这些方面并不能充分解释种族和族裔差异。
Are health care affordability, availability, and accessibility associated with racial and ethnic disparities in consulting a gynecologic oncologist and receiving surgery for ovarian cancer? In this cohort study of 8987 patients, health care availability and affordability scores were associated with gynecologic oncologist consultation, while affordability scores were associated with surgery receipt. However, non-Hispanic Black patients were less likely than non-Hispanic White patients to consult a gynecologic oncologist and have surgery even after adjusting for these health care access factors. These findings suggest that affordability and availability were significantly associated with indicators of guideline-adherent care but did not fully explain disparities. This cohort study assesses health care affordability, availability, and accessibility along with race and ethnicity in association with receipt of guideline-adherent care for ovarian cancer. Poor health care access (HCA) is associated with racial and ethnic disparities in ovarian cancer (OC) survival. To generate composite scores representing health care affordability, availability, and accessibility via factor analysis and to evaluate the association between each score and key indicators of guideline-adherent care. This retrospective cohort study used data from patients with OC diagnosed between 2008 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) Medicare database. The SEER Medicare database uses cancer registry data and linked Medicare claims from 12 US states. Included patients were Hispanic, non-Hispanic Black, and non-Hispanic White individuals aged 65 years or older diagnosed from 2008 to 2015 with first or second primary OC of any histologic type (International Classification of Diseases for Oncology, 3rd Edition [ICD-O-3] code C569). Data were analyzed from June 2020 to June 2022. The SEER-Medicare data set was linked with publicly available data sets to obtain 35 variables representing health care affordability, availability, and accessibility. A composite score was created for each dimension using confirmatory factor analysis followed by a promax (oblique) rotation on multiple component variables. The main outcomes were consultation with a gynecologic oncologist for OC and receipt of OC-related surgery in the 2 months prior to or 6 months after diagnosis. The cohort included 8987 patients, with a mean (SD) age of 76.8 (7.3) years and 612 Black patients (6.8%), 553 Hispanic patients (6.2%), and 7822 White patients (87.0%). Black patients (adjusted odds ratio [aOR], 0.75; 95% CI, 0.62-0.91) and Hispanic patients (aOR, 0.81; 95% CI, 0.67-0.99) were less likely to consult a gynecologic oncologist compared with White patients, and Black patients were less likely to receive surgery after adjusting for demographic and clinical characteristics (aOR, 0.76; 95% CI, 0.62-0.94). HCA availability and affordability were each associated with gynecologic oncologist consultation (availability: aOR, 1.16; 95% CI, 1.09-1.24; affordability: aOR, 1.13; 95% CI, 1.07-1.20), while affordability was associated with receipt of OC surgery (aOR, 1.08; 95% CI, 1.01-1.15). In models mutually adjusted for availability, affordability, and accessibility, Black patients remained less likely to consult a gynecologic oncologist (aOR, 0.80; 95% CI, 0.66-0.97) and receive surgery (aOR, 0.80; 95% CI, 0.65-0.99). In this cohort study of Hispanic, non-Hispanic Black, and non-Hispanic White patients with OC, HCA affordability and availability were significantly associated with receiving surgery and consulting a gynecologic oncologist. However, these dimensions did not fully explain racial and ethnic disparities.
登录
查看更多内容
影响因子：
4.7
作者：
Esselen, Katharine M.;Stack-Dunnbier, Hannah;Hacker, Michele R.
通讯作者：
Hacker, Michele R.
影响因子：
2.3
作者：
Clegg, Limin X.;Reichman, Marsha E.;Edwards, Brenda K.
通讯作者：
Edwards, Brenda K.
影响因子：
11.5
作者：
Bandera, Elisa V.;Lee, Valerie S.;Kushi, Lawrence H.
通讯作者：
Kushi, Lawrence H.
影响因子：
4.9
作者：
Chen, Xuewei;Orom, Heather;Kiviniemi, Marc T.
通讯作者：
Kiviniemi, Marc T.
影响因子：
3.7
作者：
Goldberg EM;Berger Y;Sood D;Kurnit KC;Kim JS;Lee NK;Yamada SD;Turaga KK;Eng OS
通讯作者：
Eng OS