Race/ethnic associations with comprehensive cancer center access and clinical trial enrollment for acute leukemia.
Race/ethnic associations with comprehensive cancer center access and clinical trial enrollment for acute leukemia.
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种族/民族与综合癌症中心准入和急性白血病临床试验注册的关联。
DOI：
10.1093/jnci/djae067
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Abel,GregoryA
中科院分区：
文献类型：
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作者：
Hantel,Andrew;Brunner,AndrewM;Plascak,JesseJ;Uno,Hajime;Varela,JuanC;Luskin,MarliseR;Rebbeck,TimothyR;Stone,RichardM;Lathan,ChristopherS;DeAngelo,DanielJ;Abel,GregoryA
背景 对于患有急性白血病的少数种族和族裔群体来说，综合癌症中心 (CCC) 的临床试验参与是不公平的。 CCC 照顾大部分患有急性白血病的成人。目前尚不清楚参与不平等是否是由于 CCC 准入、准入后注册或两者兼而有之。方法我们对居住在马萨诸塞州（丹纳法伯/哈佛大学癌症中心 (DF/HCC) 指定服务区）的急性白血病成人患者（2010-2019 年）进行了一项回顾性队列研究。个体被分类为非西班牙裔亚裔 (NHA)、黑人 (NHB)、白人 (NHW)、西班牙裔白人 (HW) 或其他。分解分析评估了协变量对 (1) 获得 DF/HCC 护理和 (2) 获得后登记方面差异的贡献。结果 在 3698 名急性白血病患者中，85.9% 为 NHW、4.5% HW、4.3% NHB、3.7% NHA 和 1.3% 其他。与 NHW 相比，HW 的访问率较低（年龄和性别调整 OR = 0.64，95% CI = 0.45 至 0.90），HW 的访问后注册率较低（aOR = 0.54，95% CI = 0.34 至 0.86）和 NHB（aOR = 0.60，95% CI = 0.39 至 0.92）。医疗服务获取方面+1.1%的绝对差异中，付款人和社会经济地位（SES）分别占25.2%和21.2%。婚姻状况和社会经济地位分别占家庭卫生入学人数-8.8%绝对差距的8.0%和7.0%； 76.4% 的差异无法解释。 NHB 入学人数绝对差异 -9.1% 中，SES 和婚姻状况分别占 8.2% 和 7.1%； 73.0% 的差异无法解释。结论 CCC 的急性白血病试验入组中种族和民族不平等的很大一部分来自入组后，其中大部分不能用社会人口因素来解释。
BackgroundClinical trial participation at Comprehensive Cancer Centers (CCC) is inequitable for minoritized racial and ethnic groups with acute leukemia. CCCs care for a high proportion of adults with acute leukemia. It is unclear if participation inequities are due to CCC access, post-access enrollment, or both.MethodsWe conducted a retrospective cohort study of adults with acute leukemia (2010-2019) residing within Massachusetts, the designated catchment area of the Dana-Farber/Harvard Cancer Center (DF/HCC). Individuals were categorized as non-Hispanic Asian (NHA), Black (NHB), White (NHW), Hispanic White (HW), or Other. Decomposition analyses assessed covariate contributions to disparities in (1) access to DF/HCC care and (2) post-access enrollment.ResultsOf 3698 individuals with acute leukemia, 85.9% were NHW, 4.5% HW, 4.3% NHB, 3.7% NHA, and 1.3% Other. Access was lower for HW (age- and sex-adjusted OR = 0.64, 95% CI = 0.45 to 0.90) and reduced post-access enrollment for HW (aOR = 0.54, 95% CI =0.34 to 0.86) and NHB (aOR = 0.60, 95% CI = 0.39 to 0.92) compared to NHW. Payor and socioeconomic status (SES) accounted for 25.2% and 21.2% of the +1.1% absolute difference in HW access. Marital status and SES accounted for 8.0% and 7.0% of the -8.8% absolute disparity in HW enrollment; 76.4% of the disparity was unexplained. SES and marital status accounted for 8.2% and 7.1% of the -9.1% absolute disparity in NHB enrollment; 73.0% of the disparity was unexplained.ConclusionsA substantial proportion of racial and ethnic inequities in acute leukemia trial enrollment at CCCs are from post-access enrollment, the majority of which was not explained by sociodemographic factors.