Association Between Race/Ethnicity and Insurance Status with Outcomes in Patients with Hepatocellular Carcinoma.
Association Between Race/Ethnicity and Insurance Status with Outcomes in Patients with Hepatocellular Carcinoma.
复制标题
DOI：
10.1007/s10620-019-05890-2
复制
发表时间：
2020-06
影响因子：
3.1
通讯作者：
Parikh ND
中科院分区：
文献类型：
--
作者：
Scaglione S;Adams W;Caines A;Devlin P;Mittal S;Singal AG;Parikh ND
据报道，肝细胞癌（HCC）患者的预后存在种族/民族差异;然而，很少有研究在保险状况的背景下评估种族/民族差异。在来自美国的多中心多样化HCC患者队列中，描述早期肿瘤检测、接受治愈性治疗和总生存期的种族/民族和保险状况。我们纳入了2012年6月至2013年5月在美国四家中心诊断的HCC患者。使用广义线性混合效应模型比较早期肿瘤检测（使用米兰标准定义）和治愈性治疗（肝移植、手术切除或局部消融）作为患者种族/民族和保险状态的函数。多变量虚弱生存模型用于比较患者组之间的死亡风险。在379例HCC患者中（52.8%非西班牙裔白色人，19.5%西班牙裔白色人，19.8%黑人），46.4%和48.0%分别在早期发现并接受了治愈性治疗，队列的中位总生存期为25.7个月。在调整后的模型中，HCC的早期发现与胃肠病学专科护理和接受HCC监测相关，而与种族/民族或保险状况无关。然而，商业保险与更高的治愈性治疗接受几率显著相关，这反过来又与总生存率最强相关。在调整健康系统和保险状况后，种族/民族与接受治疗或总生存期无关。保险状况和获得胃肠病学专科护理可能是HCC患者预后中种族/民族差异的重要驱动因素。
Racial/ethnic disparities in prognosis have been reported in patients with hepatocellular carcinoma (HCC); however, few studies have evaluated racial/ethnic disparities in the context of insurance status. Characterize racial/ethnic and insurance status in early tumor detection, receipt of curative therapy and overall survival in a multicenter diverse cohort of HCC patients from the USA. We included patients with HCC diagnosed between June 2012 and May 2013 at four centers in the USA. Generalized linear mixed effects models were used to compare early tumor detection (defined using Milan Criteria) and curative treatment receipt (liver transplantation, surgical resection, or local ablation) as a function of patient race/ethnicity and insurance status. A multivariable frailty survival model was used to compare risk of death between patient groups. Of 379 HCC patients (52.8% non-Hispanic White, 19.5% Hispanic White, 19.8% Black), 46.4% and 48.0% were found at an early stage and underwent curative therapy, respectively, and median overall survival of the cohort was 25.7 months. Early detection of HCC was associated with gastroenterology subspecialty care and receipt of HCC surveillance but not race/ethnicity or insurance status in adjusted models. However, commercial insurance was significantly associated with higher odds of curative treatment receipt, which in turn was the strongest correlate for overall survival. After adjusting for health system and insurance status, race/ethnicity was not associated with curative treatment receipt or overall survival. Insurance status and access to gastroenterology subspecialty care may be important drivers of racial/ethnic disparities in prognosis among HCC patients.
登录
查看更多内容
影响因子：
29.4
作者：
Serper M;Taddei TH;Mehta R;D'Addeo K;Dai F;Aytaman A;Baytarian M;Fox R;Hunt K;Goldberg DS;Valderrama A;Kaplan DE;VOCAL Study Group
通讯作者：
VOCAL Study Group
影响因子：
--
作者：
Mathur, Amit K.;Osborne, Nicholas H.;Sonnenday, Christopher J.
通讯作者：
Sonnenday, Christopher J.
DOI：
10.1002/hep.27388
发表时间：
2015-01
期刊：
Hepatology (Baltimore, Md.)
影响因子：
--
作者：
Njei B;Rotman Y;Ditah I;Lim JK
通讯作者：
Lim JK
影响因子：
12.6
作者：
Simmons, Okeefe L.;Feng, Yuan;Singal, Amit G.
通讯作者：
Singal, Amit G.
影响因子：
6.2
作者：
Mokdad, Ali A.;Murphy, Caitlin C.;Yopp, Adam C.
通讯作者：
Yopp, Adam C.