Association of area-level mortgage denial and guideline-concordant non-small-cell lung cancer care and outcomes in the United States.
Association of area-level mortgage denial and guideline-concordant non-small-cell lung cancer care and outcomes in the United States.
复制标题
美国地区级抵押贷款拒绝和符合指南的非小细胞肺癌护理和结果协会。
DOI：
10.1002/cam4.6921
复制
发表时间：
2024
期刊：
影响因子：
4
通讯作者：
Nogueira,Leticia
中科院分区：
文献类型：
--
作者：
Fan,Qinjin;Hussaini,SMQasim;Barrow,LaurenCJ;Feliciano,JosephineL;Pollack,CraigE;Yabroff,KRobin;Nogueira,Leticia
背景接受非小细胞肺癌(NSCLC)治疗的种族和社会经济差异被很好地描述。然而，以前没有研究评估抵押贷款拒绝率与接受及时和符合指南的非小细胞肺癌护理和患者结果之间的关系。方法我们从国家癌症数据库中确定了2014年至2019年期间被诊断为非小细胞肺癌的患者≥18 年。使用住房抵押贷款披露法案数据库，我们计算了被拒绝的住房贷款在邮政编码水平上占总贷款的比例，并将其归类为五分之一。结果在629,288名被诊断为非小细胞肺癌的患者中(中位年龄69岁；智商61-76 岁，女性49.1%)，47.8%的患者没有接受符合指南的治疗。居住在抵押贷款拒绝率较高和收入较低的地区，总体上与指导方针一致性较差(ARR = 1.28；95%CI = 1.25-1.32)相关，对于每种癌症治疗方式，接受及时化疗的情况较差(AHR = 1.14；95%CI = 1.11-1.17)和总体生存率较差(AHR = 1.21；95%CI = 1.19~1.22)，与居住在抵押拒绝率最低和收入最高的地区相比。结论面积级抵押贷款拒绝率与接受及时和符合指南的非小细胞肺癌护理和生存相关。这突显了了解和解决系统性做法的迫切需要，例如拒绝抵押贷款，这些做法限制了获得资源的机会，并与获得高质量癌症护理和结果的机会更差有关。
BackgroundRacial and socioeconomic disparities in receipt of care for non‐small‐cell lung cancer (NSCLC) are well described. However, no previous studies have evaluated the association between mortgage denial rates and receipt of timely and guideline‐concordant care for NSCLC and patient outcomes.MethodsWe identified individuals ≥18 years diagnosed with NSCLC between 2014 and 2019 from the National Cancer Database. Using the Home Mortgage Disclosure Act database, we calculated the proportion of denied home loans to total loans at the zip‐code level and categorized them into quintiles. Our outcomes included receipt of guideline‐concordant care based on clinical and pathologic stage at diagnosis and the National Comprehensive Cancer Network guidelines, time from surgery to chemotherapy initiation, and overall survival.ResultsOf the 629,288 individuals diagnosed with NSCLC (median age 69; IQR 61–76 years, 49.1% female), 47.8% did not receive guideline‐concordant care. Residing in areas with higher mortgage denial rates and lower income was associated with worse guideline‐concordant care overall (aRR = 1.28; 95% CI = 1.25–1.32) and for each cancer treatment modality, worse receipt of timely chemotherapy (aHR = 1.14; 95% CI = 1.11–1.17) and worse overall survival (aHR = 1.21; 95% CI = 1.19–1.22), compared with residing in areas with the lowest mortgage denial rate and highest income.ConclusionsArea‐level mortgage denial rate was associated with worse receipt of timely and guideline‐concordant NSCLC care and survival. This highlights the critical need to understand and address systemic practices, such as mortgage denial, that limit access to resources and are associated with worse access to quality cancer care and outcomes.
登录
查看更多内容
大鼠大脑中的皮质激素受体：醛固酮受体的证据。
影响因子：
4.8
作者：
Norman S. Anderson;Darrell D. Fanestil
通讯作者：
Darrell D. Fanestil
一些新的活性皮质类固醇
DOI：
--
发表时间：
1957
期刊：
影响因子：
--
作者：
D. H. Gould;E. Shapiro;Hersfel L. Herzog;M. Gentles;E. Hershberg;W. Charney;M. L. Gilmore;S. Tolksdorf;M. Eisler;P. L. Perlman;M. Pechet
通讯作者：
M. Pechet
影响因子：
56.9
作者：
SAPOLSKY, RM;PULSINELLI, WA
通讯作者：
PULSINELLI, WA
二甲亚砜和5-氟尿嘧啶无法打开血脑屏障。
影响因子：
4.8
作者：
Neuwelt,EA;Barnett,P;Barranger,J;McCormick,C;Pagel,M;Frenkel,E
通讯作者：
Frenkel,E
各种组织和亚细胞颗粒对皮质醇和可的松的代谢。
DOI：
10.1016/s0021-9258(18)69528-6
发表时间：
1960
期刊：
The Journal of biological chemistry
影响因子：
--
作者：
V. Mahesh;F. Ulrich
通讯作者：
F. Ulrich