Exploring racial disparities in treatment patterns and outcomes for patients with multiple myeloma using real world data.
Exploring racial disparities in treatment patterns and outcomes for patients with multiple myeloma using real world data.
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DOI：
10.1038/s41408-022-00665-x
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发表时间：
2022-04-19
影响因子：
12.8
通讯作者：
Gormley, Nicole J.
中科院分区：
文献类型：
--
作者：
Maignan, Kathleen;Fashoyin-Aje, Lola A.;Torres, Aracelis Z.;Fernandes, Laura L.;Gwise, Thomas;Baxi, Shrujal B.;Roose, James P.;Rivera, Donna R.;Shen, Yuan Li;Kluetz, Paul G.;Gormley, Nicole J.
本回顾性观察性研究评估了黑人和白人多发性骨髓瘤（MM）患者的种族差异。我们纳入了来自纵向去识别ehr衍生数据库的患者，这些患者在2011年1月1日或之后有≥2次就诊记录，有治疗记录，种族为白人或黑人。黑人患者（n = 1172）比白人患者（n = 4637）更倾向于女性（54.8%/42.9%）和年轻（<65岁，40.8%/30.8%）。与一线治疗（LOT）相关的未调整中位真实世界总生存期（rwOS）黑人为64.6个月（95% CI: 57.8-74.0），白人为54.5个月（95% CI: 50.9-56.2）。调整后的rwOS估计值（性别、指数日期的年龄和实践类型）与第一lot （aHR = 0.94; 95% CI: 0.84-1.06）或第二lot （aHR = 0.90; 95% CI: 0.77-1.05）相似。第一次lot时，黑人未调整的衍生反应率（dRR）为84.8% (95% CI: 80.7-88.1)，白人为86.9% (95% CI: 85.0-88.5)（优势比[OR] = 0.78 [95% CI: 0.57-1.10]）；第二lot中黑人占67.2% (95% CI: 58.4-75.0)，白人占72.4% (95% CI: 68.1-76.3) （OR = 0.72 [95% CI: 0.46-1.13]）。尽管观察数据源、回顾性设计和新导出的终点的分析使用存在固有的局限性，但黑人患者的高代表性使该分析具有鲁棒性，需要进一步验证。
This retrospective observational study evaluated racial disparities among Black and White patients with multiple myeloma (MM). We included patients from a longitudinal de-identified EHR-derived database who had ≥2 visits recorded on or after 1/1/2011, documented treatment, and race listed as White or Black. Black patients (n = 1172) were more likely female (54.8%/42.9%) and younger (<65 years, 40.8%/30.8%) than White patients (n = 4637). Unadjusted median real-world overall survival (rwOS) indexed to first-line of therapy (LOT) was 64.6 months (95% CI: 57.8–74.0) for Blacks and 54.5 months (95% CI: 50.9–56.2) for Whites. Adjusted rwOS estimates (for sex, age at index date, and practice type) to either first- (aHR = 0.94; 95% CI: 0.84–1.06) or second-LOT (aHR = 0.90; 95% CI: 0.77–1.05) were similar. Unadjusted derived response rate (dRR) during first-LOT was 84.8% (95% CI: 80.7–88.1) for Blacks and 86.9% (95% CI: 85.0–88.5) for Whites (odds ratio [OR] = 0.78 [95% CI: 0.57–1.10]); in second-LOT, 67.2% (95% CI: 58.4–75.0) for Blacks and 72.4% (95% CI: 68.1–76.3) for Whites (OR = 0.72 [95% CI: 0.46–1.13]). High representation of Black patients enabled this robust analysis, albeit with limitations inherent to the observational data source, the retrospective design, and the analytic use of newly derived endpoints requiring further validation.
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