Associations Between Race/Ethnicity and US Childhood and Adolescent Cancer Survival by Treatment Amenability
Associations Between Race/Ethnicity and US Childhood and Adolescent Cancer Survival by Treatment Amenability
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DOI：
10.1001/jamapediatrics.2019.6074
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发表时间：
2020-05-01
期刊：
影响因子：
26.1
通讯作者：
Johnson, Kimberly J.
中科院分区：
文献类型：
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作者：
Delavar, Arash;Barnes, Justin M.;Johnson, Kimberly J.
尽管美国的癌症存活率随着时间的推移而增加，但种族/民族的差异仍然存在，包括儿童和青少年。目的检查儿童和青少年癌症存活率中的种族/民族差异是否因癌症类型而异，相对存活率(RSR)是医疗干预可补救的标志。设计、背景和参与者使用美国监测、流行病学和最终结果数据进行了一项回溯性队列研究，从2000年1月1日到2016年12月31日，67061名儿童和青少年被诊断为首次原发恶性肿瘤，年龄在0到19岁之间。数据分析于2019年6月19日至11月3日进行。参与者从被诊断为癌症死亡的日期或随访期结束时进行随访，以较早者为准。暴露的种族/民族定义为非西班牙裔白人、非西班牙裔黑人、非西班牙裔美国印第安人/阿拉斯加原住民、非西班牙裔亚洲人或太平洋岛民或西班牙裔(任何种族)。主要结果和衡量癌症可修复性的指标是103种癌症的5年RSR。结果在67061例癌症病例中，男性36064例，占53.8%；大多数人是非西班牙裔白人(35186人[52.5%])，其次是任何种族的西班牙裔(19220人[28.7%])，非西班牙裔黑人(7100人[10.6%])，非西班牙裔亚洲人或太平洋岛民(4981人[7.4%])，以及非西班牙裔美国印第安人/阿拉斯加原住民(574人[0.9%])。平均发病年龄为9.66岁(6.41岁)。与非西班牙裔白人儿童和青少年相比，非西班牙裔黑人患者(高：AHR，1.59；95%CI，1.41-1.80vs低：AHR，1.35；95%CI，1.24-1.47；交互作用P=0.002)和西班牙裔(任何种族)患者(高：AHR，1.63；95%CI，1.50-1.78 vs低：AHR，1.16；95%CI，1.08-1.25；P
Importance Although US cancer survival rates have increased over time, disparities by race/ethnicity remain, including for children and adolescents.Objective To examine whether racial/ethnic disparities in childhood and adolescent cancer survival vary by cancer type according to relative survival rates (RSRs), a marker for amenability to medical intervention.Design, Setting, and Participants In a retrospective cohort study using US Surveillance, Epidemiology, and End Results data, 67 061 children and adolescents diagnosed at ages 0 to 19 years with a first primary malignant cancer from January 1, 2000, to December 31, 2016, were evaluated. Data analysis was performed from June 19 to November 3, 2019. Participants were followed up from the dates of diagnosis to cancer death or the end of the follow-up period, whichever came first.Exposures Race/ethnicity defined as non-Hispanic white, non-Hispanic black, non-Hispanic American Indian/Alaskan Native, non-Hispanic Asian or Pacific Islander, or Hispanic (any race).Main Outcomes and Measures Cancer amenability was defined using 5-year RSRs for 103 cancer types. Cox proportional hazards regression was used to compute adjusted hazard ratios (aHRs) and 95% CIs for the association between race/ethnicity and cancer survival for high (> 85% RSR), medium (70%-85% RSR), and low (< 70% RSR) amenability categories.Results Among 67 061 cancer cases, 36 064 were male (53.8%); most individuals were non-Hispanic white (35 186 [52.5%]) followed by Hispanic of any race (19 220 [28.7%]), non-Hispanic black (7100 [10.6%]), non-Hispanic Asian or Pacific Islander (4981 [7.4%]), and non-Hispanic American Indian/Alaskan Native (574 [0.9%]). Mean (SD) age at diagnosis was 9.66 (6.41) years. Compared with non-Hispanic white children and adolescents, a higher aHR of death was observed for high- than low-amenability cancers for non-Hispanic black patients (high: aHR, 1.59; 95% CI, 1.41-1.80 vs low: aHR, 1.35; 95% CI, 1.24-1.47; P = .002 for interaction) and Hispanic (any race) patients (high: aHR, 1.63; 95% CI, 1.50-1.78 vs low: aHR, 1.16; 95% CI, 1.08-1.25; P